- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,541.98 / $13,689.10
| Facility | | $6,303.00 | $6,541.98 | $13,689.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,640.45 / $11,883.58 / $15,945.20
| Facility | | $8,640.45 | $11,883.58 | $15,945.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.33 / $9,721.81 / $13,628.38
| Facility | | $7,079.33 | $9,721.81 | $13,628.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,163.20 / $10,797.16 / $13,611.68
| Facility | | $6,163.20 | $10,797.16 | $13,611.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,163.20 / $10,887.04 / $14,276.15
| Facility | | $6,163.20 | $10,887.04 | $14,276.15 |