- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,426.17 / $7,974.56 / $12,312.00
| Facility | | $5,426.17 | $7,974.56 | $12,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,688.02 / $9,508.02 / $12,189.77
| Facility | | $6,688.02 | $9,508.02 | $12,189.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,106.96 / $11,807.24 / $14,934.02
| Facility | | $6,106.96 | $11,807.24 | $14,934.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,426.17 / $8,156.59 / $13,042.70
| Facility | | $5,426.17 | $8,156.59 | $13,042.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,345.84 / $10,851.47 / $16,486.54
| Facility | | $6,345.84 | $10,851.47 | $16,486.54 |