- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,947.28 / $7,270.76 / $11,225.40
| Facility | | $4,947.28 | $7,270.76 | $11,225.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,109.36 / $15,793.60 / $20,248.21
| Facility | | $11,109.36 | $15,793.60 | $20,248.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,567.99 / $10,765.18 / $13,616.01
| Facility | | $5,567.99 | $10,765.18 | $13,616.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,947.28 / $7,436.72 / $11,891.60
| Facility | | $4,947.28 | $7,436.72 | $11,891.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,785.79 / $9,893.77 / $15,031.51
| Facility | | $5,785.79 | $9,893.77 | $15,031.51 |