- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,881.00 / $9,534.24 / $14,534.40
| Facility | | $4,881.00 | $9,534.24 | $14,534.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,267.20 / $10,612.61 / $17,935.12
| Facility | | $6,267.20 | $10,612.61 | $17,935.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,672.01 / $9,111.98 / $14,318.61
| Facility | | $5,672.01 | $9,111.98 | $14,318.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,826.48 / $5,826.48 / $5,826.48
| Facility | | $5,826.48 | $5,826.48 | $5,826.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,707.76 / $8,712.35 / $19,427.21
| Facility | | $3,707.76 | $8,712.35 | $19,427.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,244.46 / $17,264.04
| Facility | | $3,308.00 | $8,244.46 | $17,264.04 |