- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,545.42 / $11,989.60 / $16,976.00
| Facility | | $6,545.42 | $11,989.60 | $16,976.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,469.13 / $11,995.91 / $19,214.79
| Facility | | $7,469.13 | $11,995.91 | $19,214.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,805.26 / $10,785.31 / $19,188.77
| Facility | | $6,805.26 | $10,785.31 | $19,188.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.39 / $10,290.00 / $22,690.76
| Facility | | $5,052.39 | $10,290.00 | $22,690.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,954.24 / $20,164.18
| Facility | | $3,308.00 | $9,954.24 | $20,164.18 |