- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,042.02 / $6,285.14 / $12,800.00
| Facility | | $6,042.02 | $6,285.14 | $12,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,079.22 / $11,111.70 / $14,909.51
| Facility | | $8,079.22 | $11,111.70 | $14,909.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.51 / $9,090.34 / $12,743.17
| Facility | | $6,619.51 | $9,090.34 | $12,743.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,762.88 / $10,095.85 / $12,727.56
| Facility | | $5,762.88 | $10,095.85 | $12,727.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,762.88 / $10,179.89 / $13,348.87
| Facility | | $5,762.88 | $10,179.89 | $13,348.87 |