- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $11,220.18
| Facility | | $6,918.31 | $8,128.31 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $17,782.79 / $17,782.79
| Facility | | $1,621.81 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $11,220.18
| Facility | | $6,918.31 | $8,128.31 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |