- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,934.41 / $5,782.20 / $9,062.96
| Facility | | $3,934.41 | $5,782.20 | $9,062.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,286.10 / $8,286.10 / $8,286.10
| Facility | | $8,286.10 | $8,286.10 | $8,286.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,392.31 / $7,665.97 / $9,828.17
| Facility | | $5,392.31 | $7,665.97 | $9,828.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,428.04 / $8,561.20 / $10,828.37
| Facility | | $4,428.04 | $8,561.20 | $10,828.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,934.41 / $5,914.19 / $9,457.04
| Facility | | $3,934.41 | $5,914.19 | $9,457.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,601.25 / $7,868.19 / $11,954.07
| Facility | | $4,601.25 | $7,868.19 | $11,954.07 |