- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,840.54 / $7,034.94 / $9,960.71
| Facility | | $3,840.54 | $7,034.94 | $9,960.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,646.01 / $7,376.57 / $11,722.20
| Facility | | $4,646.01 | $7,376.57 | $11,722.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,993.00 / $6,328.30 / $11,259.05
| Facility | | $3,993.00 | $6,328.30 | $11,259.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $6,324.03 / $13,313.85
| Facility | | $3,308.00 | $6,324.03 | $13,313.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,964.50 / $6,324.03 / $11,831.38
| Facility | | $2,964.50 | $6,324.03 | $11,831.38 |