- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,165.97 / $8,186.96 / $13,592.30
| Facility | | $5,165.97 | $8,186.96 | $13,592.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,856.67 / $7,434.80 / $12,324.99
| Facility | | $4,856.67 | $7,434.80 | $12,324.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,078.00 / $8,732.34 / $12,503.65
| Facility | | $7,078.00 | $8,732.34 | $12,503.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,386.88 / $8,787.00 / $21,717.13
| Facility | | $4,386.88 | $8,787.00 | $21,717.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,386.88 / $8,580.03 / $11,763.84
| Facility | | $4,386.88 | $8,580.03 | $11,763.84 |