- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,089.33 / $6,303.00 / $12,900.20
| Facility | | $6,089.33 | $6,303.00 | $12,900.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,142.48 / $11,198.70 / $15,026.24
| Facility | | $8,142.48 | $11,198.70 | $15,026.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,671.34 / $9,161.52 / $12,842.94
| Facility | | $6,671.34 | $9,161.52 | $12,842.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,808.00 / $10,174.89 / $12,827.21
| Facility | | $5,808.00 | $10,174.89 | $12,827.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,808.00 / $10,259.59 / $13,453.39
| Facility | | $5,808.00 | $10,259.59 | $13,453.39 |