- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,673.29 / $9,690.71 / $12,652.60
| Facility | | $4,673.29 | $9,690.71 | $12,652.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,849.62 / $23,697.54
| Facility | | $5,840.42 | $8,849.62 | $23,697.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,475.58 / $9,053.99 / $13,680.69
| Facility | | $5,475.58 | $9,053.99 | $13,680.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,857.60 / $12,857.60 / $12,857.60
| Facility | | $12,857.60 | $12,857.60 | $12,857.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,889.24 / $9,121.08 / $14,085.09
| Facility | | $7,889.24 | $9,121.08 | $14,085.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,849.62 / $23,697.54
| Facility | | $5,840.42 | $8,849.62 | $23,697.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,735.31 / $18,519.84
| Facility | | $5,840.42 | $8,735.31 | $18,519.84 |