- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,055.46 / $10,483.20 / $13,687.30
| Facility | | $5,055.46 | $10,483.20 | $13,687.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,573.31 / $25,635.46
| Facility | | $5,840.42 | $9,573.31 | $25,635.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,923.36 / $9,794.40 / $14,799.46
| Facility | | $5,923.36 | $9,794.40 | $14,799.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,909.06 / $13,909.06 / $13,909.06
| Facility | | $13,909.06 | $13,909.06 | $13,909.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,534.40 / $9,866.98 / $15,236.93
| Facility | | $8,534.40 | $9,866.98 | $15,236.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,573.31 / $25,635.46
| Facility | | $5,840.42 | $9,573.31 | $25,635.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,449.66 / $20,034.34
| Facility | | $5,840.42 | $9,449.66 | $20,034.34 |