- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,212.53 / $7,716.34 / $10,925.50
| Facility | | $4,212.53 | $7,716.34 | $10,925.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,526.96 / $4,526.96 / $4,526.96
| Facility | | $4,526.96 | $4,526.96 | $4,526.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,891.84 / $8,025.55 / $12,941.17
| Facility | | $4,891.84 | $8,025.55 | $12,941.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,379.76 / $6,941.26 / $12,349.60
| Facility | | $4,379.76 | $6,941.26 | $12,349.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $6,733.55 / $14,603.42
| Facility | | $3,308.00 | $6,733.55 | $14,603.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $6,936.57 / $12,977.36
| Facility | | $3,000.00 | $6,936.57 | $12,977.36 |