- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $7,020.91 / $14,691.30
| Facility | | $6,303.00 | $7,020.91 | $14,691.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,273.00 / $12,753.56 / $17,112.53
| Facility | | $9,273.00 | $12,753.56 | $17,112.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,597.60 / $10,433.53 / $14,626.09
| Facility | | $7,597.60 | $10,433.53 | $14,626.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,614.40 / $11,587.60 / $14,608.18
| Facility | | $6,614.40 | $11,587.60 | $14,608.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,614.40 / $11,684.06 / $15,321.29
| Facility | | $6,614.40 | $11,684.06 | $15,321.29 |