- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,291.87 / $8,899.79 / $11,619.90
| Facility | | $4,291.87 | $8,899.79 | $11,619.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,779.17 / $8,127.34 / $21,763.43
| Facility | | $5,779.17 | $8,127.34 | $21,763.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.68 / $8,315.04 / $12,564.12
| Facility | | $5,028.68 | $8,315.04 | $12,564.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,789.58 / $11,789.58 / $11,789.58
| Facility | | $11,789.58 | $11,789.58 | $11,789.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,245.35 / $8,376.65 / $12,935.52
| Facility | | $7,245.35 | $8,376.65 | $12,935.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,779.17 / $8,127.34 / $21,763.43
| Facility | | $5,779.17 | $8,127.34 | $21,763.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,779.17 / $8,022.37 / $17,008.32
| Facility | | $5,779.17 | $8,022.37 | $17,008.32 |