- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,963.80 / $7,238.88 / $11,751.00
| Facility | | $4,963.80 | $7,238.88 | $11,751.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,820.34 / $15,382.72 / $19,721.43
| Facility | | $10,820.34 | $15,382.72 | $19,721.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,828.67 / $11,269.18 / $14,253.48
| Facility | | $5,828.67 | $11,269.18 | $14,253.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,178.89 / $7,784.89 / $12,448.40
| Facility | | $5,178.89 | $7,784.89 | $12,448.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,816.12 / $10,356.96 / $15,735.25
| Facility | | $6,816.12 | $10,356.96 | $15,735.25 |