- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,331.02 / $7,834.72 / $12,096.10
| Facility | | $5,331.02 | $7,834.72 | $12,096.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,815.86 / $18,219.66 / $23,358.54
| Facility | | $12,815.86 | $18,219.66 | $23,358.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,999.87 / $11,600.19 / $14,672.14
| Facility | | $5,999.87 | $11,600.19 | $14,672.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,331.02 / $8,013.56 / $12,814.00
| Facility | | $5,331.02 | $8,013.56 | $12,814.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,234.56 / $10,661.18 / $16,197.43
| Facility | | $6,234.56 | $10,661.18 | $16,197.43 |