- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,272.65 / $9,658.21 / $13,675.00
| Facility | | $5,272.65 | $9,658.21 | $13,675.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,540.09 / $8,941.36 / $14,126.39
| Facility | | $5,540.09 | $8,941.36 | $14,126.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,481.96 / $8,688.08 / $15,457.47
| Facility | | $5,481.96 | $8,688.08 | $15,457.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,069.94 / $8,120.40 / $18,278.48
| Facility | | $4,069.94 | $8,120.40 | $18,278.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,069.94 / $8,595.29 / $18,278.48
| Facility | | $4,069.94 | $8,595.29 | $18,278.48 |