- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $9,772.37
| Facility | | $3,890.45 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,079.46 / $11,481.54
| Facility | | $4,677.35 | $7,079.46 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,762.47 / $11,481.54
| Facility | | $3,715.35 | $7,762.47 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,754.40 / $11,481.54
| Facility | | $3,311.31 | $5,754.40 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $10,964.78
| Facility | | $3,311.31 | $6,165.95 | $10,964.78 |