- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $7,286.87 / $15,247.80
| Facility | | $6,303.00 | $7,286.87 | $15,247.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,624.27 / $13,236.68 / $17,760.77
| Facility | | $9,624.27 | $13,236.68 | $17,760.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,885.41 / $10,828.76 / $15,180.14
| Facility | | $7,885.41 | $10,828.76 | $15,180.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,864.96 / $12,026.55 / $15,161.55
| Facility | | $6,864.96 | $12,026.55 | $15,161.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,864.96 / $12,126.67 / $15,901.68
| Facility | | $6,864.96 | $12,126.67 | $15,901.68 |