- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,460.46 / $13,518.50
| Facility | | $6,303.00 | $6,460.46 | $13,518.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,532.78 / $11,735.50 / $15,746.51
| Facility | | $8,532.78 | $11,735.50 | $15,746.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,991.12 / $9,600.66 / $13,458.55
| Facility | | $6,991.12 | $9,600.66 | $13,458.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,086.40 / $10,662.61 / $13,442.07
| Facility | | $6,086.40 | $10,662.61 | $13,442.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,086.40 / $10,751.37 / $14,098.26
| Facility | | $6,086.40 | $10,751.37 | $14,098.26 |