- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,471.87 / $8,041.72 / $12,415.70
| Facility | | $5,471.87 | $8,041.72 | $12,415.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,222.82 / $14,533.26 / $18,632.38
| Facility | | $10,222.82 | $14,533.26 | $18,632.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,158.39 / $11,906.68 / $15,059.79
| Facility | | $6,158.39 | $11,906.68 | $15,059.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,471.87 / $8,225.28 / $13,152.60
| Facility | | $5,471.87 | $8,225.28 | $13,152.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,399.29 / $10,942.86 / $16,625.38
| Facility | | $6,399.29 | $10,942.86 | $16,625.38 |