- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,585.78 / $12,302.69
| Facility | | $5,370.32 | $7,585.78 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,232.93 / $12,302.69
| Facility | | $5,623.41 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,495.41 / $8,912.51
| Facility | | $2,818.38 | $5,495.41 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,943.28 / $14,125.38
| Facility | | $4,677.35 | $7,943.28 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $21,877.62 / $21,877.62
| Facility | | $18,620.87 | $21,877.62 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,413.10 / $12,302.69
| Facility | | $2,884.03 | $7,413.10 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,760.83 / $15,848.93
| Facility | | $4,677.35 | $6,760.83 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,456.54 / $14,454.40
| Facility | | $2,754.23 | $6,456.54 | $14,454.40 |