- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,404.42 / $13,401.30
| Facility | | $6,303.00 | $6,404.42 | $13,401.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,458.76 / $11,633.69 / $15,609.90
| Facility | | $8,458.76 | $11,633.69 | $15,609.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,930.47 / $9,517.37 / $13,341.80
| Facility | | $6,930.47 | $9,517.37 | $13,341.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,033.60 / $10,570.11 / $13,325.46
| Facility | | $6,033.60 | $10,570.11 | $13,325.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,033.60 / $10,658.10 / $13,975.95
| Facility | | $6,033.60 | $10,658.10 | $13,975.95 |