- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,471.29 / $16,982.44
| Facility | | $6,918.31 | $10,471.29 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,585.78 / $13,182.57
| Facility | | $3,715.35 | $7,585.78 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,964.78 / $20,417.38
| Facility | | $6,456.54 | $10,964.78 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $25,703.96 / $25,703.96
| Facility | | $25,703.96 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $9,772.37 / $16,982.44
| Facility | | $3,981.07 | $9,772.37 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,332.54 / $21,877.62
| Facility | | $6,456.54 | $9,332.54 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,912.51 / $19,952.62
| Facility | | $3,715.35 | $8,912.51 | $19,952.62 |