- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,613.31 / $13,838.40
| Facility | | $6,303.00 | $6,613.31 | $13,838.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,734.66 / $12,013.15 / $16,119.06
| Facility | | $8,734.66 | $12,013.15 | $16,119.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,156.52 / $9,827.81 / $13,776.97
| Facility | | $7,156.52 | $9,827.81 | $13,776.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,230.40 / $10,914.88 / $13,760.10
| Facility | | $6,230.40 | $10,914.88 | $13,760.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,230.40 / $11,005.74 / $14,431.81
| Facility | | $6,230.40 | $11,005.74 | $14,431.81 |