- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,932.83 / $10,228.90 / $13,355.30
| Facility | | $4,932.83 | $10,228.90 | $13,355.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,341.10 / $25,013.64
| Facility | | $5,840.42 | $9,341.10 | $25,013.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,779.68 / $9,556.83 / $14,440.48
| Facility | | $5,779.68 | $9,556.83 | $14,440.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,660.97 / $12,660.97 / $12,660.97
| Facility | | $12,660.97 | $12,660.97 | $12,660.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,327.39 / $9,627.64 / $14,867.34
| Facility | | $8,327.39 | $9,627.64 | $14,867.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,341.10 / $25,013.64
| Facility | | $5,840.42 | $9,341.10 | $25,013.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,220.45 / $19,548.38
| Facility | | $5,840.42 | $9,220.45 | $19,548.38 |