- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.02 / $6,576.50 / $10,675.70
| Facility | | $4,705.02 | $6,576.50 | $10,675.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,503.72 / $14,932.60 / $19,144.36
| Facility | | $10,503.72 | $14,932.60 | $19,144.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,295.33 / $10,238.02 / $12,949.25
| Facility | | $5,295.33 | $10,238.02 | $12,949.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.02 / $7,072.56 / $11,309.30
| Facility | | $4,705.02 | $7,072.56 | $11,309.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,502.46 / $9,409.28 / $14,295.43
| Facility | | $5,502.46 | $9,409.28 | $14,295.43 |