- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,681.58 / $13,981.20
| Facility | | $6,303.00 | $6,681.58 | $13,981.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,824.83 / $12,137.17 / $16,285.46
| Facility | | $8,824.83 | $12,137.17 | $16,285.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,230.40 / $9,929.27 / $13,919.20
| Facility | | $7,230.40 | $9,929.27 | $13,919.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,294.72 / $11,027.56 / $13,902.15
| Facility | | $6,294.72 | $11,027.56 | $13,902.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,294.72 / $11,119.36 / $14,580.80
| Facility | | $6,294.72 | $11,119.36 | $14,580.80 |