- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $8,128.31 / $8,128.31
| Facility | | $7,413.10 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,737.80 / $5,011.87
| Facility | | $1,621.81 | $1,737.80 | $5,011.87 |
- 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
- $7,413.10 / $8,128.31 / $8,128.31
| Facility | | $7,413.10 | $8,128.31 | $8,128.31 |
- 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 |