- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.60 / $6,047.13 / $9,816.37
| Facility | | $4,146.60 | $6,047.13 | $9,816.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,970.54 / $9,909.67 / $12,704.70
| Facility | | $6,970.54 | $9,909.67 | $12,704.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,869.08 / $9,413.92 / $11,906.90
| Facility | | $4,869.08 | $9,413.92 | $11,906.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,326.29 / $6,503.25 / $10,399.00
| Facility | | $4,326.29 | $6,503.25 | $10,399.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,059.54 / $8,651.87 / $13,144.72
| Facility | | $5,059.54 | $8,651.87 | $13,144.72 |