- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,847.68 / $14,328.80
| Facility | | $6,303.00 | $6,847.68 | $14,328.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,044.20 / $12,438.89 / $16,690.30
| Facility | | $9,044.20 | $12,438.89 | $16,690.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,410.14 / $10,176.10 / $14,265.22
| Facility | | $7,410.14 | $10,176.10 | $14,265.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,451.20 / $11,301.70 / $14,247.74
| Facility | | $6,451.20 | $11,301.70 | $14,247.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,451.20 / $11,395.78 / $14,943.26
| Facility | | $6,451.20 | $11,395.78 | $14,943.26 |