- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,621.53 / $6,633.77 / $9,392.70
| Facility | | $3,621.53 | $6,633.77 | $9,392.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,335.59 / $6,998.11 / $11,597.13
| Facility | | $4,335.59 | $6,998.11 | $11,597.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,765.30 / $5,967.43 / $10,617.01
| Facility | | $3,765.30 | $5,967.43 | $10,617.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $5,963.40 / $12,554.63
| Facility | | $3,308.00 | $5,963.40 | $12,554.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,795.45 / $5,963.40 / $11,156.70
| Facility | | $2,795.45 | $5,963.40 | $11,156.70 |