- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,756.56 / $8,712.86 / $12,336.50
| Facility | | $4,756.56 | $8,712.86 | $12,336.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,373.98 / $8,730.79 / $14,088.30
| Facility | | $5,373.98 | $8,730.79 | $14,088.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,945.38 / $7,837.68 / $13,944.47
| Facility | | $4,945.38 | $7,837.68 | $13,944.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.57 / $7,464.14 / $16,489.37
| Facility | | $3,671.57 | $7,464.14 | $16,489.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,147.06 / $7,473.00 / $14,653.31
| Facility | | $3,147.06 | $7,473.00 | $14,653.31 |