- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,754.54 / $9,859.20 / $12,872.60
| Facility | | $4,754.54 | $9,859.20 | $12,872.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,003.46 / $24,109.54
| Facility | | $5,840.42 | $9,003.46 | $24,109.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,570.78 / $9,211.40 / $13,918.54
| Facility | | $5,570.78 | $9,211.40 | $13,918.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,081.14 / $13,081.14 / $13,081.14
| Facility | | $13,081.14 | $13,081.14 | $13,081.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,026.40 / $9,279.66 / $14,329.97
| Facility | | $8,026.40 | $9,279.66 | $14,329.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,003.46 / $24,109.54
| Facility | | $5,840.42 | $9,003.46 | $24,109.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,887.18 / $18,841.82
| Facility | | $5,840.42 | $8,887.18 | $18,841.82 |