- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,543.16 / $5,207.20 / $8,039.46
| Facility | | $3,543.16 | $5,207.20 | $8,039.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,439.59 / $9,154.84 / $11,736.98
| Facility | | $6,439.59 | $9,154.84 | $11,736.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,987.70 / $7,709.85 / $9,751.56
| Facility | | $3,987.70 | $7,709.85 | $9,751.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,543.16 / $5,326.06 / $8,516.60
| Facility | | $3,543.16 | $5,326.06 | $8,516.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,143.68 / $7,085.75 / $10,765.32
| Facility | | $4,143.68 | $7,085.75 | $10,765.32 |