- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,925.31 / $10,213.29 / $13,334.90
| Facility | | $4,925.31 | $10,213.29 | $13,334.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,326.86 / $24,975.50
| Facility | | $5,840.42 | $9,326.86 | $24,975.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,770.87 / $9,542.25 / $14,418.46
| Facility | | $5,770.87 | $9,542.25 | $14,418.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,550.98 / $13,550.98 / $13,550.98
| Facility | | $13,550.98 | $13,550.98 | $13,550.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,314.69 / $9,612.95 / $14,844.67
| Facility | | $8,314.69 | $9,612.95 | $14,844.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,326.86 / $24,975.50
| Facility | | $5,840.42 | $9,326.86 | $24,975.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,206.39 / $19,518.57
| Facility | | $5,840.42 | $9,206.39 | $19,518.57 |