- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,516.06 / $9,364.68 / $12,226.90
| Facility | | $4,516.06 | $9,364.68 | $12,226.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,551.87 / $22,900.24
| Facility | | $5,840.42 | $8,551.87 | $22,900.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,291.36 / $8,749.37 / $13,220.41
| Facility | | $5,291.36 | $8,749.37 | $13,220.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,425.01 / $12,425.01 / $12,425.01
| Facility | | $12,425.01 | $12,425.01 | $12,425.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,623.81 / $8,814.20 / $13,611.20
| Facility | | $7,623.81 | $8,814.20 | $13,611.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,551.87 / $22,900.24
| Facility | | $5,840.42 | $8,551.87 | $22,900.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,441.42 / $17,896.74
| Facility | | $5,840.42 | $8,441.42 | $17,896.74 |