- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,818.85 / $14,139.80 / $18,461.59
| Facility | | $6,818.85 | $14,139.80 | $18,461.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,745.80 / $34,577.35
| Facility | | $5,840.42 | $12,745.80 | $34,577.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,989.48 / $13,210.78 / $19,961.65
| Facility | | $7,989.48 | $13,210.78 | $19,961.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,760.66 / $18,760.66 / $18,760.66
| Facility | | $18,760.66 | $18,760.66 | $18,760.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,511.28 / $13,308.67 / $20,551.71
| Facility | | $11,511.28 | $13,308.67 | $20,551.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,745.80 / $34,577.35
| Facility | | $5,840.42 | $12,745.80 | $34,577.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,042.01 / $27,022.50
| Facility | | $5,840.42 | $10,042.01 | $27,022.50 |