- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,229.67 / $7,747.74 / $10,970.00
| Facility | | $4,229.67 | $7,747.74 | $10,970.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,431.88 / $7,043.95 / $11,205.65
| Facility | | $4,431.88 | $7,043.95 | $11,205.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,397.58 / $6,969.50 / $12,399.84
| Facility | | $4,397.58 | $6,969.50 | $12,399.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $6,794.26 / $14,662.84
| Facility | | $3,308.00 | $6,794.26 | $14,662.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $6,964.79 / $13,030.16
| Facility | | $3,000.00 | $6,964.79 | $13,030.16 |