- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,974.04 / $14,593.20
| Facility | | $6,303.00 | $6,974.04 | $14,593.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,211.09 / $12,668.42 / $16,998.28
| Facility | | $9,211.09 | $12,668.42 | $16,998.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,546.88 / $10,363.87 / $14,528.44
| Facility | | $7,546.88 | $10,363.87 | $14,528.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,570.24 / $11,510.24 / $14,510.65
| Facility | | $6,570.24 | $11,510.24 | $14,510.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,570.24 / $11,606.06 / $15,219.00
| Facility | | $6,570.24 | $11,606.06 | $15,219.00 |