- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $6,396.26 / $13,384.20
| Facility | | $6,303.00 | $6,396.26 | $13,384.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,447.99 / $11,618.88 / $15,590.03
| Facility | | $8,447.99 | $11,618.88 | $15,590.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,921.65 / $9,505.26 / $13,324.82
| Facility | | $6,921.65 | $9,505.26 | $13,324.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.92 / $10,556.66 / $13,308.50
| Facility | | $6,025.92 | $10,556.66 | $13,308.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.92 / $10,644.54 / $13,958.16
| Facility | | $6,025.92 | $10,644.54 | $13,958.16 |