- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,754.40 / $7,943.28
| Facility | | $3,090.30 | $5,754.40 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,248.07 / $8,511.38
| Facility | | $3,467.37 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,165.95 / $10,964.78
| Facility | | $3,019.95 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,786.30 / $9,332.54
| Facility | | $3,019.95 | $4,786.30 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,370.32 / $9,332.54
| Facility | | $2,818.38 | $5,370.32 | $9,332.54 |