- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,525.74 / $11,953.60 / $16,925.00
| Facility | | $6,525.74 | $11,953.60 | $16,925.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,460.64 / $12,134.79 / $19,581.09
| Facility | | $7,460.64 | $12,134.79 | $19,581.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,784.80 / $10,752.88 / $19,131.08
| Facility | | $6,784.80 | $10,752.88 | $19,131.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,037.20 / $10,395.84 / $22,622.54
| Facility | | $5,037.20 | $10,395.84 | $22,622.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,924.31 / $20,103.57
| Facility | | $3,308.00 | $9,924.31 | $20,103.57 |