- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,264.93 / $6,267.96 / $9,824.35
| Facility | | $4,264.93 | $6,267.96 | $9,824.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,384.89 / $8,384.89 / $8,977.45
| Facility | | $8,384.89 | $8,384.89 | $8,977.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,649.45 / $12,296.48 / $15,764.72
| Facility | | $8,649.45 | $12,296.48 | $15,764.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,800.04 / $9,280.42 / $11,738.06
| Facility | | $4,800.04 | $9,280.42 | $11,738.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,264.93 / $6,411.03 / $10,251.50
| Facility | | $4,264.93 | $6,411.03 | $10,251.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,987.80 / $8,529.19 / $12,958.33
| Facility | | $4,987.80 | $8,529.19 | $12,958.33 |