- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,776.45 / $9,959.00 / $15,375.80
| Facility | | $6,776.45 | $9,959.00 | $15,375.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,979.06 / $12,765.07 / $16,365.48
| Facility | | $8,979.06 | $12,765.07 | $16,365.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,626.66 / $14,745.43 / $18,650.30
| Facility | | $7,626.66 | $14,745.43 | $18,650.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,776.45 / $10,186.29 / $16,288.40
| Facility | | $6,776.45 | $10,186.29 | $16,288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,924.98 / $13,551.82 / $20,589.15
| Facility | | $7,924.98 | $13,551.82 | $20,589.15 |