- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,762.08 / $14,149.70
| Facility | | $6,303.00 | $6,762.08 | $14,149.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,931.15 / $12,283.40 / $16,481.66
| Facility | | $8,931.15 | $12,283.40 | $16,481.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,317.52 / $10,048.89 / $14,086.90
| Facility | | $7,317.52 | $10,048.89 | $14,086.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,370.56 / $11,160.42 / $14,069.65
| Facility | | $6,370.56 | $11,160.42 | $14,069.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,370.56 / $11,253.33 / $14,756.47
| Facility | | $6,370.56 | $11,253.33 | $14,756.47 |