- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,891.07 / $14,289.60 / $18,657.09
| Facility | | $6,891.07 | $14,289.60 | $18,657.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,880.79 / $34,943.57
| Facility | | $5,840.42 | $12,880.79 | $34,943.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,074.10 / $13,350.70 / $20,173.07
| Facility | | $8,074.10 | $13,350.70 | $20,173.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,959.37 / $18,959.37 / $18,959.37
| Facility | | $18,959.37 | $18,959.37 | $18,959.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,633.20 / $13,449.63 / $20,769.38
| Facility | | $11,633.20 | $13,449.63 | $20,769.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,880.79 / $34,943.57
| Facility | | $5,840.42 | $12,880.79 | $34,943.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,148.36 / $27,308.71
| Facility | | $5,840.42 | $10,148.36 | $27,308.71 |