- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,875.20 / $8,568.00 / $13,908.60
| Facility | | $5,875.20 | $8,568.00 | $13,908.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,152.17 / $20,119.41 / $25,794.13
| Facility | | $14,152.17 | $20,119.41 | $25,794.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,898.87 / $13,338.31 / $16,870.55
| Facility | | $6,898.87 | $13,338.31 | $16,870.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,129.79 / $9,214.27 / $14,734.00
| Facility | | $6,129.79 | $9,214.27 | $14,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,168.72 / $12,258.60 / $18,624.38
| Facility | | $7,168.72 | $12,258.60 | $18,624.38 |