- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,128.31 / $10,471.29
| Facility | | $5,495.41 | $8,128.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,548.13 / $7,413.10
| Facility | | $1,862.09 | $3,548.13 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,981.07 / $7,413.10
| Facility | | $2,884.03 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,981.07 / $7,413.10
| Facility | | $2,884.03 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,128.61 / $8,128.31
| Facility | | $3,019.95 | $5,128.61 | $8,128.31 |