- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,532.92 / $10,135.00 / $14,350.00
| Facility | | $5,532.92 | $10,135.00 | $14,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,734.00 / $9,191.61 / $14,444.21
| Facility | | $5,734.00 | $9,191.61 | $14,444.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,752.56 / $8,721.23 / $16,220.48
| Facility | | $5,752.56 | $8,721.23 | $16,220.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,270.84 / $8,569.64 / $19,180.74
| Facility | | $4,270.84 | $8,569.64 | $19,180.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,414.43 / $17,045.00
| Facility | | $3,308.00 | $8,414.43 | $17,045.00 |