- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,944.65 / $7,225.64 / $10,230.70
| Facility | | $3,944.65 | $7,225.64 | $10,230.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,362.05 / $7,123.75 / $11,526.64
| Facility | | $4,362.05 | $7,123.75 | $11,526.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,101.24 / $6,499.84 / $11,564.25
| Facility | | $4,101.24 | $6,499.84 | $11,564.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $6,305.35 / $13,674.75
| Facility | | $3,308.00 | $6,305.35 | $13,674.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $6,495.46 / $12,152.10
| Facility | | $3,000.00 | $6,495.46 | $12,152.10 |