- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,709.64 / $13,182.57
| Facility | | $6,165.95 | $8,709.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,943.28 / $15,848.93
| Facility | | $5,495.41 | $7,943.28 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,918.31 / $9,772.37
| Facility | | $3,548.13 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $13,182.57
| Facility | | $6,606.93 | $10,232.93 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,709.64 / $13,489.63
| Facility | | $5,128.61 | $8,709.64 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |