- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,182.79 / $8,673.60 / $11,324.60
| Facility | | $4,182.79 | $8,673.60 | $11,324.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,632.28 / $7,920.78 / $21,210.29
| Facility | | $5,632.28 | $7,920.78 | $21,210.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,900.87 / $8,103.70 / $12,244.79
| Facility | | $4,900.87 | $8,103.70 | $12,244.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,508.09 / $11,508.09 / $11,508.09
| Facility | | $11,508.09 | $11,508.09 | $11,508.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,061.20 / $8,163.75 / $12,606.74
| Facility | | $7,061.20 | $8,163.75 | $12,606.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,632.28 / $7,920.78 / $21,210.29
| Facility | | $5,632.28 | $7,920.78 | $21,210.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,632.28 / $7,818.47 / $16,576.03
| Facility | | $5,632.28 | $7,818.47 | $16,576.03 |