- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $7,141.15 / $14,942.90
| Facility | | $6,303.00 | $7,141.15 | $14,942.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,431.81 / $12,971.98 / $17,405.59
| Facility | | $9,431.81 | $12,971.98 | $17,405.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,727.72 / $10,612.21 / $14,876.58
| Facility | | $7,727.72 | $10,612.21 | $14,876.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,727.68 / $11,786.05 / $14,858.36
| Facility | | $6,727.68 | $11,786.05 | $14,858.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,727.68 / $11,884.17 / $15,583.69
| Facility | | $6,727.68 | $11,884.17 | $15,583.69 |