- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $7,336.80 / $15,352.30
| Facility | | $6,303.00 | $7,336.80 | $15,352.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,690.21 / $13,327.38 / $17,882.47
| Facility | | $9,690.21 | $13,327.38 | $17,882.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,939.44 / $10,902.96 / $15,284.16
| Facility | | $7,939.44 | $10,902.96 | $15,284.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,912.00 / $12,108.96 / $15,265.44
| Facility | | $6,912.00 | $12,108.96 | $15,265.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,912.00 / $12,209.76 / $16,010.64
| Facility | | $6,912.00 | $12,209.76 | $16,010.64 |