- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,145.85 / $6,609.78 / $17,561.59
| Facility | | $5,145.85 | $6,609.78 | $17,561.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,224.00 / $6,064.98 / $8,605.58
| Facility | | $4,224.00 | $6,064.98 | $8,605.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,891.32 / $5,996.16 / $10,330.04
| Facility | | $3,891.32 | $5,996.16 | $10,330.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,691.57 / $7,357.04 / $10,126.76
| Facility | | $5,691.57 | $7,357.04 | $10,126.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,728.63 / $7,429.50 / $17,400.45
| Facility | | $4,728.63 | $7,429.50 | $17,400.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,952.00 / $6,920.01 / $9,487.84
| Facility | | $3,952.00 | $6,920.01 | $9,487.84 |