- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,690.62 / $6,893.56 / $10,804.90
| Facility | | $4,690.62 | $6,893.56 | $10,804.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,929.26 / $9,929.26 / $9,929.26
| Facility | | $9,929.26 | $9,929.26 | $9,929.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,438.17 / $10,574.47 / $13,557.01
| Facility | | $7,438.17 | $10,574.47 | $13,557.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.13 / $10,206.69 / $12,909.62
| Facility | | $5,279.13 | $10,206.69 | $12,909.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,690.62 / $7,050.91 / $11,274.70
| Facility | | $4,690.62 | $7,050.91 | $11,274.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,485.63 / $9,380.49 / $14,251.69
| Facility | | $5,485.63 | $9,380.49 | $14,251.69 |