- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,011.94 / $7,348.90 / $10,405.20
| Facility | | $4,011.94 | $7,348.90 | $10,405.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.72 / $7,790.69 / $12,672.90
| Facility | | $4,769.72 | $7,790.69 | $12,672.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,171.20 / $6,610.72 / $11,761.52
| Facility | | $4,171.20 | $6,610.72 | $11,761.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $6,606.26 / $13,908.02
| Facility | | $3,308.00 | $6,606.26 | $13,908.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $6,606.26 / $12,359.39
| Facility | | $3,000.00 | $6,606.26 | $12,359.39 |