- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,232.93 / $16,595.87
| Facility | | $7,244.36 | $10,232.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,244.36 / $12,589.25
| Facility | | $3,630.78 | $7,244.36 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,715.19 / $19,952.62
| Facility | | $6,456.54 | $10,715.19 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $25,703.96 / $25,703.96
| Facility | | $25,703.96 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,772.37 / $16,595.87
| Facility | | $3,890.45 | $9,772.37 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,332.54 / $21,379.62
| Facility | | $6,309.57 | $9,332.54 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,709.64 / $19,498.45
| Facility | | $3,715.35 | $8,709.64 | $19,498.45 |