- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,929.40 / $5,774.84 / $8,915.85
| Facility | | $3,929.40 | $5,774.84 | $8,915.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,837.40 / $9,720.37 / $12,462.03
| Facility | | $6,837.40 | $9,720.37 | $12,462.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,422.39 / $8,550.29 / $10,814.59
| Facility | | $4,422.39 | $8,550.29 | $10,814.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,929.40 / $5,906.66 / $9,445.00
| Facility | | $3,929.40 | $5,906.66 | $9,445.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,595.39 / $7,858.18 / $11,938.85
| Facility | | $4,595.39 | $7,858.18 | $11,938.85 |