- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,306.95 / $9,269.00 / $14,310.50
| Facility | | $6,306.95 | $9,269.00 | $14,310.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,055.77 / $15,717.43 / $20,150.55
| Facility | | $11,055.77 | $15,717.43 | $20,150.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,098.25 / $13,723.80 / $17,358.13
| Facility | | $7,098.25 | $13,723.80 | $17,358.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,306.95 / $9,480.58 / $15,159.90
| Facility | | $6,306.95 | $9,480.58 | $15,159.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,375.91 / $12,612.89 / $19,162.65
| Facility | | $7,375.91 | $12,612.89 | $19,162.65 |