- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,125.42 / $10,628.30 / $13,876.70
| Facility | | $5,125.42 | $10,628.30 | $13,876.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,705.79 / $25,990.23
| Facility | | $5,840.42 | $9,705.79 | $25,990.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,005.33 / $9,929.95 / $15,004.27
| Facility | | $6,005.33 | $9,929.95 | $15,004.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,101.55 / $14,101.55 / $14,101.55
| Facility | | $14,101.55 | $14,101.55 | $14,101.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,652.51 / $10,003.53 / $15,447.80
| Facility | | $8,652.51 | $10,003.53 | $15,447.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,705.79 / $25,990.23
| Facility | | $5,840.42 | $9,705.79 | $25,990.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,580.44 / $20,311.59
| Facility | | $5,840.42 | $9,580.44 | $20,311.59 |