- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,277.18 / $7,755.60 / $12,156.10
| Facility | | $5,277.18 | $7,755.60 | $12,156.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,020.84 / $12,139.30 / $18,519.13
| Facility | | $11,020.84 | $12,139.30 | $18,519.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,759.00 / $15,292.70 / $19,606.02
| Facility | | $10,759.00 | $15,292.70 | $19,606.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.28 / $11,483.04 / $14,523.97
| Facility | | $5,939.28 | $11,483.04 | $14,523.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,277.18 / $7,932.63 / $12,684.60
| Facility | | $5,277.18 | $7,932.63 | $12,684.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,171.60 / $10,553.52 / $16,033.86
| Facility | | $6,171.60 | $10,553.52 | $16,033.86 |