- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,407.64 / $8,263.94 / $13,720.10
| Facility | | $5,407.64 | $8,263.94 | $13,720.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,587.51 / $6,872.37 / $11,641.94
| Facility | | $4,587.51 | $6,872.37 | $11,641.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,971.00 / $8,814.45 / $12,662.00
| Facility | | $6,971.00 | $8,814.45 | $12,662.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,428.13 / $8,849.17 / $20,513.56
| Facility | | $4,428.13 | $8,849.17 | $20,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,428.13 / $8,660.70 / $11,874.46
| Facility | | $4,428.13 | $8,660.70 | $11,874.46 |