- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $7,260.38 / $15,192.40
| Facility | | $6,303.00 | $7,260.38 | $15,192.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,589.28 / $13,188.55 / $17,696.18
| Facility | | $9,589.28 | $13,188.55 | $17,696.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,856.74 / $10,789.39 / $15,124.95
| Facility | | $7,856.74 | $10,789.39 | $15,124.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,840.00 / $11,982.83 / $15,106.43
| Facility | | $6,840.00 | $11,982.83 | $15,106.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,840.00 / $12,082.58 / $15,843.86
| Facility | | $6,840.00 | $12,082.58 | $15,843.86 |