- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,381.72 / $7,909.24 / $12,211.20
| Facility | | $5,381.72 | $7,909.24 | $12,211.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,042.16 / $22,806.32 / $29,238.87
| Facility | | $16,042.16 | $22,806.32 | $29,238.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,056.94 / $11,710.52 / $14,811.69
| Facility | | $6,056.94 | $11,710.52 | $14,811.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,381.72 / $8,089.78 / $12,935.90
| Facility | | $5,381.72 | $8,089.78 | $12,935.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,293.86 / $10,762.58 / $16,351.49
| Facility | | $6,293.86 | $10,762.58 | $16,351.49 |