- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,125.38 / $9,388.45 / $13,293.00
| Facility | | $5,125.38 | $9,388.45 | $13,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,445.27 / $8,794.44 / $13,894.27
| Facility | | $5,445.27 | $8,794.44 | $13,894.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,328.84 / $8,445.40 / $15,025.71
| Facility | | $5,328.84 | $8,445.40 | $15,025.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,956.26 / $7,968.23 / $17,767.93
| Facility | | $3,956.26 | $7,968.23 | $17,767.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $7,968.23 / $15,789.51
| Facility | | $3,308.00 | $7,968.23 | $15,789.51 |