- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,499.00 / $8,019.38 / $13,018.00
| Facility | | $5,499.00 | $8,019.38 | $13,018.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,754.36 / $19,553.88 / $25,069.08
| Facility | | $13,754.36 | $19,553.88 | $25,069.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,457.12 / $12,484.23 / $15,790.30
| Facility | | $6,457.12 | $12,484.23 | $15,790.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,737.29 / $8,624.26 / $13,790.60
| Facility | | $5,737.29 | $8,624.26 | $13,790.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,709.70 / $11,473.66 / $17,431.83
| Facility | | $6,709.70 | $11,473.66 | $17,431.83 |