- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,757.88 / $5,522.76 / $8,526.66
| Facility | | $3,757.88 | $5,522.76 | $8,526.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,236.83 / $10,288.24 / $13,190.05
| Facility | | $7,236.83 | $10,288.24 | $13,190.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,229.35 / $8,177.07 / $10,342.51
| Facility | | $4,229.35 | $8,177.07 | $10,342.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,757.88 / $5,648.82 / $9,032.70
| Facility | | $3,757.88 | $5,648.82 | $9,032.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,394.80 / $7,515.16 / $11,417.71
| Facility | | $4,394.80 | $7,515.16 | $11,417.71 |