- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,811.03 / $10,245.20 / $13,284.80
| Facility | | $6,811.03 | $10,245.20 | $13,284.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,870.79 / $10,191.00 / $13,803.18
| Facility | | $5,870.79 | $10,191.00 | $13,803.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,817.00 / $4,817.00 / $4,817.00
| Facility | | $4,817.00 | $4,817.00 | $4,817.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $7,979.00 / $12,663.00
| Facility | | $5,431.00 | $7,979.00 | $12,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $12,588.52 / $19,529.00
| Facility | | $6,098.00 | $12,588.52 | $19,529.00 |