- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,482.51 / $8,057.36 / $12,439.90
| Facility | | $5,482.51 | $8,057.36 | $12,439.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,306.94 / $9,714.48 / $12,773.49
| Facility | | $5,306.94 | $9,714.48 | $12,773.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,592.82 / $13,637.63 / $17,484.14
| Facility | | $9,592.82 | $13,637.63 | $17,484.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,170.37 / $11,929.83 / $15,089.08
| Facility | | $6,170.37 | $11,929.83 | $15,089.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,482.51 / $8,241.28 / $13,178.20
| Facility | | $5,482.51 | $8,241.28 | $13,178.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,411.73 / $10,964.14 / $16,657.72
| Facility | | $6,411.73 | $10,964.14 | $16,657.72 |