- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $8,128.31 / $13,489.63
| Facility | | $3,890.45 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,585.78 / $21,877.62
| Facility | | $5,248.07 | $7,585.78 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,762.47 / $11,748.98
| Facility | | $4,570.88 | $7,762.47 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,413.10 / $19,952.62
| Facility | | $5,248.07 | $7,413.10 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,585.78 / $21,877.62
| Facility | | $5,248.07 | $7,585.78 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,456.54 / $17,378.01
| Facility | | $4,570.88 | $6,456.54 | $17,378.01 |