- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,522.80 / $6,595.75 / $10,707.00
| Facility | | $4,522.80 | $6,595.75 | $10,707.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,509.41 / $9,254.10 / $11,864.23
| Facility | | $6,509.41 | $9,254.10 | $11,864.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,310.83 / $10,267.99 / $12,987.15
| Facility | | $5,310.83 | $10,267.99 | $12,987.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,718.79 / $7,093.26 / $11,342.40
| Facility | | $4,718.79 | $7,093.26 | $11,342.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,210.56 / $9,436.82 / $14,337.28
| Facility | | $6,210.56 | $9,436.82 | $14,337.28 |