- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,552.79 / $8,339.60 / $11,808.00
| Facility | | $4,552.79 | $8,339.60 | $11,808.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,393.00 / $8,664.39 / $14,339.93
| Facility | | $5,393.00 | $8,664.39 | $14,339.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,733.52 / $7,501.91 / $13,347.09
| Facility | | $4,733.52 | $7,501.91 | $13,347.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,514.28 / $7,276.20 / $15,782.96
| Facility | | $3,514.28 | $7,276.20 | $15,782.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,012.24 / $7,313.29 / $14,025.56
| Facility | | $3,012.24 | $7,313.29 | $14,025.56 |