- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,318.77 / $6,347.08 / $9,799.34
| Facility | | $4,318.77 | $6,347.08 | $9,799.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,722.22 / $19,722.22 / $19,722.22
| Facility | | $19,722.22 | $19,722.22 | $19,722.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,886.51 / $12,633.50 / $16,196.80
| Facility | | $8,886.51 | $12,633.50 | $16,196.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,860.63 / $9,397.57 / $11,886.23
| Facility | | $4,860.63 | $9,397.57 | $11,886.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,318.77 / $6,491.96 / $10,380.90
| Facility | | $4,318.77 | $6,491.96 | $10,380.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,050.76 / $8,636.86 / $13,121.90
| Facility | | $5,050.76 | $8,636.86 | $13,121.90 |