- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $7,030.08 / $14,710.50
| Facility | | $6,303.00 | $7,030.08 | $14,710.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,285.12 / $12,770.22 / $17,134.88
| Facility | | $9,285.12 | $12,770.22 | $17,134.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,607.53 / $10,447.16 / $14,645.20
| Facility | | $7,607.53 | $10,447.16 | $14,645.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,623.04 / $11,602.74 / $14,627.26
| Facility | | $6,623.04 | $11,602.74 | $14,627.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,623.04 / $11,699.32 / $15,341.31
| Facility | | $6,623.04 | $11,699.32 | $15,341.31 |