- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,918.31 / $9,549.93
| Facility | | $3,715.35 | $6,918.31 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $8,128.31
| Facility | | $7,413.10 | $7,413.10 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,309.57 / $10,232.93
| Facility | | $4,168.69 | $6,309.57 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,413.10 / $10,232.93
| Facility | | $3,630.78 | $7,413.10 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,623.41 / $10,964.78
| Facility | | $3,311.31 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,025.60 / $10,715.19
| Facility | | $3,311.31 | $6,025.60 | $10,715.19 |