- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,787.30 / $5,566.00 / $8,593.42
| Facility | | $3,787.30 | $5,566.00 | $8,593.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,252.67 / $7,467.45 / $9,573.66
| Facility | | $5,252.67 | $7,467.45 | $9,573.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,262.47 / $8,241.09 / $10,423.49
| Facility | | $4,262.47 | $8,241.09 | $10,423.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,787.30 / $5,693.05 / $9,103.44
| Facility | | $3,787.30 | $5,693.05 | $9,103.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,429.21 / $7,574.00 / $11,507.10
| Facility | | $4,429.21 | $7,574.00 | $11,507.10 |