- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,281.62 / $8,916.26 / $15,690.00
| Facility | | $5,281.62 | $8,916.26 | $15,690.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,555.84 / $8,133.99 / $13,449.09
| Facility | | $5,555.84 | $8,133.99 | $13,449.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.46 / $8,218.61 / $11,831.04
| Facility | | $4,804.46 | $8,218.61 | $11,831.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,474.09 / $17,474.09 / $20,507.34
| Facility | | $17,474.09 | $17,474.09 | $20,507.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $7,770.44 / $11,099.18
| Facility | | $1,787.00 | $7,770.44 | $11,099.18 |