- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,423.78 / $13,441.80
| Facility | | $6,303.00 | $6,423.78 | $13,441.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,484.33 / $11,668.86 / $15,657.09
| Facility | | $8,484.33 | $11,668.86 | $15,657.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,951.42 / $9,546.15 / $13,382.13
| Facility | | $6,951.42 | $9,546.15 | $13,382.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,051.84 / $10,602.07 / $13,365.74
| Facility | | $6,051.84 | $10,602.07 | $13,365.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,051.84 / $10,690.32 / $14,018.20
| Facility | | $6,051.84 | $10,690.32 | $14,018.20 |