- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,479.20 / $7,990.50 / $12,971.10
| Facility | | $5,479.20 | $7,990.50 | $12,971.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,679.67 / $19,447.70 / $24,932.95
| Facility | | $13,679.67 | $19,447.70 | $24,932.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,433.87 / $12,439.28 / $15,733.44
| Facility | | $6,433.87 | $12,439.28 | $15,733.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,716.63 / $8,593.20 / $13,740.90
| Facility | | $5,716.63 | $8,593.20 | $13,740.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,685.54 / $11,432.35 / $17,369.06
| Facility | | $6,685.54 | $11,432.35 | $17,369.06 |