- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,728.21 / $9,804.60 / $12,801.30
| Facility | | $4,728.21 | $9,804.60 | $12,801.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,953.61 / $23,976.02
| Facility | | $5,840.42 | $8,953.61 | $23,976.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,539.93 / $9,160.39 / $13,841.46
| Facility | | $5,539.93 | $9,160.39 | $13,841.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,008.69 / $13,008.69 / $13,008.69
| Facility | | $13,008.69 | $13,008.69 | $13,008.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,981.95 / $9,228.27 / $14,250.61
| Facility | | $7,981.95 | $9,228.27 | $14,250.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,953.61 / $23,976.02
| Facility | | $5,840.42 | $8,953.61 | $23,976.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,837.96 / $18,737.47
| Facility | | $5,840.42 | $8,837.96 | $18,737.47 |