- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,356.63 / $10,544.60 / $14,150.00
| Facility | | $6,356.63 | $10,544.60 | $14,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,915.45 / $5,915.45 / $5,915.45
| Facility | | $5,915.45 | $5,915.45 | $5,915.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,228.01 / $8,951.49 / $13,708.17
| Facility | | $5,228.01 | $8,951.49 | $13,708.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,784.52 / $8,773.00 / $19,470.97
| Facility | | $5,784.52 | $8,773.00 | $19,470.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,160.34 / $8,363.21 / $12,056.93
| Facility | | $6,160.34 | $8,363.21 | $12,056.93 |