- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $7,219.62 / $15,107.10
| Facility | | $6,303.00 | $7,219.62 | $15,107.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,535.45 / $13,114.51 / $17,596.84
| Facility | | $9,535.45 | $13,114.51 | $17,596.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,812.63 / $10,728.82 / $15,040.04
| Facility | | $7,812.63 | $10,728.82 | $15,040.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,801.60 / $11,915.55 / $15,021.62
| Facility | | $6,801.60 | $11,915.55 | $15,021.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,801.60 / $12,014.74 / $15,754.91
| Facility | | $6,801.60 | $12,014.74 | $15,754.91 |