- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,753.83 / $10,539.60 / $14,923.00
| Facility | | $5,753.83 | $10,539.60 | $14,923.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,672.70 / $9,115.45 / $14,324.05
| Facility | | $5,672.70 | $9,115.45 | $14,324.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,982.24 / $9,480.94 / $16,868.09
| Facility | | $5,982.24 | $9,480.94 | $16,868.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,441.35 / $8,694.04 / $19,946.56
| Facility | | $4,441.35 | $8,694.04 | $19,946.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,750.39 / $17,725.56
| Facility | | $3,308.00 | $8,750.39 | $17,725.56 |