- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,747.93 / $8,447.44 / $13,042.10
| Facility | | $5,747.93 | $8,447.44 | $13,042.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,878.84 / $11,714.33 / $13,724.06
| Facility | | $8,878.84 | $11,714.33 | $13,724.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,214.90 / $15,943.65 / $20,440.58
| Facility | | $11,214.90 | $15,943.65 | $20,440.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.89 / $12,049.54 / $15,819.59
| Facility | | $1,018.89 | $12,049.54 | $15,819.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,747.93 / $8,640.26 / $13,816.20
| Facility | | $5,747.93 | $8,640.26 | $13,816.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,722.14 / $11,494.95 / $17,464.16
| Facility | | $6,722.14 | $11,494.95 | $17,464.16 |