- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $7,308.27 / $15,292.60
| Facility | | $6,303.00 | $7,308.27 | $15,292.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,652.54 / $13,275.55 / $17,812.91
| Facility | | $9,652.54 | $13,275.55 | $17,812.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,908.56 / $10,860.56 / $15,224.72
| Facility | | $7,908.56 | $10,860.56 | $15,224.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,885.12 / $12,061.87 / $15,206.07
| Facility | | $6,885.12 | $12,061.87 | $15,206.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,885.12 / $12,162.28 / $15,948.38
| Facility | | $6,885.12 | $12,162.28 | $15,948.38 |