- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.57 / $10,394.29 / $13,571.20
| Facility | | $5,012.57 | $10,394.29 | $13,571.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,492.11 / $25,418.01
| Facility | | $5,840.42 | $9,492.11 | $25,418.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,873.11 / $9,711.32 / $14,673.92
| Facility | | $5,873.11 | $9,711.32 | $14,673.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,791.08 / $13,791.08 / $13,791.08
| Facility | | $13,791.08 | $13,791.08 | $13,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,462.01 / $9,783.28 / $15,107.69
| Facility | | $8,462.01 | $9,783.28 | $15,107.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,492.11 / $25,418.01
| Facility | | $5,840.42 | $9,492.11 | $25,418.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,369.51 / $19,864.40
| Facility | | $5,840.42 | $9,369.51 | $19,864.40 |