- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,104.68 / $6,032.44 / $9,313.56
| Facility | | $4,104.68 | $6,032.44 | $9,313.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,243.92 / $14,563.26 / $18,670.84
| Facility | | $10,243.92 | $14,563.26 | $18,670.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,619.68 / $8,931.70 / $11,297.00
| Facility | | $4,619.68 | $8,931.70 | $11,297.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,104.68 / $6,170.14 / $9,866.32
| Facility | | $4,104.68 | $6,170.14 | $9,866.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,800.38 / $8,208.70 / $12,471.41
| Facility | | $4,800.38 | $8,208.70 | $12,471.41 |