- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,591.43 / $8,217.44 / $12,687.00
| Facility | | $5,591.43 | $8,217.44 | $12,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,890.98 / $9,796.56 / $12,559.69
| Facility | | $6,890.98 | $9,796.56 | $12,559.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,292.96 / $12,166.85 / $15,388.86
| Facility | | $6,292.96 | $12,166.85 | $15,388.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,591.43 / $8,405.01 / $13,440.00
| Facility | | $5,591.43 | $8,405.01 | $13,440.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,539.12 / $11,181.97 / $16,988.66
| Facility | | $6,539.12 | $11,181.97 | $16,988.66 |