- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.99 / $8,925.00 / $12,641.10
| Facility | | $4,873.99 | $8,925.00 | $12,641.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,660.67 / $8,972.20 / $14,241.90
| Facility | | $5,660.67 | $8,972.20 | $14,241.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,067.47 / $8,031.19 / $14,288.76
| Facility | | $5,067.47 | $8,031.19 | $14,288.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,762.22 / $7,896.00 / $16,896.48
| Facility | | $3,762.22 | $7,896.00 | $16,896.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,224.76 / $7,577.42 / $15,015.10
| Facility | | $3,224.76 | $7,577.42 | $15,015.10 |