- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,543.23 / $8,146.60 / $12,577.60
| Facility | | $5,543.23 | $8,146.60 | $12,577.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,486.05 / $16,329.14 / $20,934.80
| Facility | | $11,486.05 | $16,329.14 | $20,934.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,238.71 / $12,061.96 / $15,256.20
| Facility | | $6,238.71 | $12,061.96 | $15,256.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,543.23 / $8,332.54 / $13,324.10
| Facility | | $5,543.23 | $8,332.54 | $13,324.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,482.75 / $11,085.57 / $16,842.21
| Facility | | $6,482.75 | $11,085.57 | $16,842.21 |