- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,165.75 / $7,591.84 / $11,721.10
| Facility | | $5,165.75 | $7,591.84 | $11,721.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,205.98 / $10,244.37 / $13,133.82
| Facility | | $7,205.98 | $10,244.37 | $13,133.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,813.87 / $11,240.58 / $14,217.30
| Facility | | $5,813.87 | $11,240.58 | $14,217.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,165.75 / $7,765.13 / $12,416.80
| Facility | | $5,165.75 | $7,765.13 | $12,416.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,041.29 / $9,865.27 / $15,514.59
| Facility | | $6,041.29 | $9,865.27 | $15,514.59 |