- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.58 / $9,890.40 / $12,913.30
| Facility | | $4,769.58 | $9,890.40 | $12,913.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,031.95 / $24,185.83
| Facility | | $5,840.42 | $9,031.95 | $24,185.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,588.41 / $9,240.54 / $13,962.58
| Facility | | $5,588.41 | $9,240.54 | $13,962.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,905.20 / $12,905.20 / $12,905.20
| Facility | | $12,905.20 | $12,905.20 | $12,905.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,051.80 / $9,309.02 / $14,375.32
| Facility | | $8,051.80 | $9,309.02 | $14,375.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,031.95 / $24,185.83
| Facility | | $5,840.42 | $9,031.95 | $24,185.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,915.31 / $18,901.43
| Facility | | $5,840.42 | $8,915.31 | $18,901.43 |