- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,235.24 / $7,693.96 / $12,059.40
| Facility | | $5,235.24 | $7,693.96 | $12,059.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,649.70 / $11,358.84 / $14,954.03
| Facility | | $9,649.70 | $11,358.84 | $14,954.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,526.85 / $17,808.78 / $22,831.77
| Facility | | $12,526.85 | $17,808.78 | $22,831.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,892.08 / $11,391.78 / $14,408.54
| Facility | | $5,892.08 | $11,391.78 | $14,408.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,235.24 / $7,869.58 / $12,583.80
| Facility | | $5,235.24 | $7,869.58 | $12,583.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,122.55 / $10,010.51 / $15,723.28
| Facility | | $6,122.55 | $10,010.51 | $15,723.28 |