- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,162.38 / $7,624.48 / $10,795.40
| Facility | | $4,162.38 | $7,624.48 | $10,795.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,827.93 / $7,993.27 / $13,284.23
| Facility | | $4,827.93 | $7,993.27 | $13,284.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,327.62 / $6,858.62 / $12,202.58
| Facility | | $4,327.62 | $6,858.62 | $12,202.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $6,986.35 / $14,429.57
| Facility | | $3,308.00 | $6,986.35 | $14,429.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $6,853.99 / $12,822.87
| Facility | | $3,000.00 | $6,853.99 | $12,822.87 |