- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,631.04 / $7,257.65 / $14,749.50
| Facility | | $5,631.04 | $7,257.65 | $14,749.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,662.10 / $7,662.10 / $7,662.10
| Facility | | $7,662.10 | $7,662.10 | $7,662.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,285.95 / $6,626.05 / $7,575.29
| Facility | | $5,285.95 | $6,626.05 | $7,575.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,494.78 / $7,956.23 / $10,347.41
| Facility | | $4,494.78 | $7,956.23 | $10,347.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,811.42 / $8,811.42 / $8,811.42
| Facility | | $8,811.42 | $8,811.42 | $8,811.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $6,380.70 / $9,826.43
| Facility | | $1,286.00 | $6,380.70 | $9,826.43 |