- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,027.93 / $6,270.48 / $12,770.10
| Facility | | $6,027.93 | $6,270.48 | $12,770.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,060.38 / $11,085.79 / $14,874.74
| Facility | | $8,060.38 | $11,085.79 | $14,874.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,604.07 / $9,069.14 / $12,713.45
| Facility | | $6,604.07 | $9,069.14 | $12,713.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,749.44 / $10,072.29 / $12,697.88
| Facility | | $5,749.44 | $10,072.29 | $12,697.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,749.44 / $10,156.15 / $13,317.74
| Facility | | $5,749.44 | $10,156.15 | $13,317.74 |