- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,204.80 / $6,132.00 / $9,954.16
| Facility | | $4,204.80 | $6,132.00 | $9,954.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,380.11 / $13,335.23 / $17,096.45
| Facility | | $9,380.11 | $13,335.23 | $17,096.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,937.42 / $9,546.04 / $12,074.02
| Facility | | $4,937.42 | $9,546.04 | $12,074.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,387.01 / $6,594.53 / $10,544.90
| Facility | | $4,387.01 | $6,594.53 | $10,544.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,130.56 / $8,773.32 / $13,329.22
| Facility | | $5,130.56 | $8,773.32 | $13,329.22 |