- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,734.80 / $8,363.25 / $13,576.20
| Facility | | $5,734.80 | $8,363.25 | $13,576.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,270.10 / $16,022.14 / $20,541.20
| Facility | | $11,270.10 | $16,022.14 | $20,541.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,734.00 / $13,019.56 / $16,467.39
| Facility | | $6,734.00 | $13,019.56 | $16,467.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,983.31 / $8,994.08 / $14,381.90
| Facility | | $5,983.31 | $8,994.08 | $14,381.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,997.41 / $11,965.66 / $18,179.32
| Facility | | $6,997.41 | $11,965.66 | $18,179.32 |