- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,992.26 / $10,352.20 / $13,516.20
| Facility | | $4,992.26 | $10,352.20 | $13,516.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,453.65 / $25,315.01
| Facility | | $5,840.42 | $9,453.65 | $25,315.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,849.32 / $9,671.96 / $14,614.46
| Facility | | $5,849.32 | $9,671.96 | $14,614.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,735.19 / $13,735.19 / $13,735.19
| Facility | | $13,735.19 | $13,735.19 | $13,735.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,427.71 / $9,743.64 / $15,046.47
| Facility | | $8,427.71 | $9,743.64 | $15,046.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,453.65 / $25,315.01
| Facility | | $5,840.42 | $9,453.65 | $25,315.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,331.54 / $19,783.91
| Facility | | $5,840.42 | $9,331.54 | $19,783.91 |