- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,650.90 / $8,304.84 / $12,822.00
| Facility | | $5,650.90 | $8,304.84 | $12,822.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,979.06 / $12,765.07 / $16,365.48
| Facility | | $8,979.06 | $12,765.07 | $16,365.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,359.89 / $12,296.25 / $15,552.54
| Facility | | $6,359.89 | $12,296.25 | $15,552.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,650.90 / $8,494.41 / $13,582.90
| Facility | | $5,650.90 | $8,494.41 | $13,582.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,608.67 / $10,791.78 / $16,971.66
| Facility | | $6,608.67 | $10,791.78 | $16,971.66 |