- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $7,496.78 / $15,687.10
| Facility | | $6,303.00 | $7,496.78 | $15,687.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,901.52 / $13,617.99 / $18,272.40
| Facility | | $9,901.52 | $13,617.99 | $18,272.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,112.56 / $11,140.71 / $15,617.44
| Facility | | $8,112.56 | $11,140.71 | $15,617.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,062.72 / $12,373.00 / $15,598.31
| Facility | | $7,062.72 | $12,373.00 | $15,598.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,062.72 / $12,476.00 / $16,359.76
| Facility | | $7,062.72 | $12,476.00 | $16,359.76 |