- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,199.56 / $7,641.52 / $11,797.80
| Facility | | $5,199.56 | $7,641.52 | $11,797.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,869.06 / $11,869.06 / $11,869.06
| Facility | | $11,869.06 | $11,869.06 | $11,869.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,518.53 / $16,375.30 / $20,993.98
| Facility | | $11,518.53 | $16,375.30 | $20,993.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,851.92 / $11,314.13 / $14,310.33
| Facility | | $5,851.92 | $11,314.13 | $14,310.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,199.56 / $7,815.95 / $12,498.00
| Facility | | $5,199.56 | $7,815.95 | $12,498.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,080.82 / $9,929.82 / $15,616.11
| Facility | | $6,080.82 | $9,929.82 | $15,616.11 |