- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.43 / $6,943.97 / $11,621.70
| Facility | | $5,032.43 | $6,943.97 | $11,621.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,586.78 / $6,586.78 / $6,586.78
| Facility | | $6,586.78 | $6,586.78 | $6,586.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $7,889.97 / $12,151.84
| Facility | | $2,423.00 | $7,889.97 | $12,151.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,150.66 / $7,812.26 / $13,101.12
| Facility | | $5,150.66 | $7,812.26 | $13,101.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $6,304.93 / $14,019.74
| Facility | | $2,600.00 | $6,304.93 | $14,019.74 |