- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,865.78 / $8,044.76 / $18,187.00
| Facility | | $5,865.78 | $8,044.76 | $18,187.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,811.46 / $7,207.86 / $12,210.27
| Facility | | $4,811.46 | $7,207.86 | $12,210.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,927.21 / $8,571.85 / $12,325.27
| Facility | | $6,927.21 | $8,571.85 | $12,325.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,306.25 / $8,640.75 / $21,514.98
| Facility | | $4,306.25 | $8,640.75 | $21,514.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,306.25 / $8,422.34 / $11,547.64
| Facility | | $4,306.25 | $8,422.34 | $11,547.64 |