- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,722.77 / $7,375.87 / $14,989.70
| Facility | | $5,722.77 | $7,375.87 | $14,989.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,160.42 / $5,407.16 / $8,029.62
| Facility | | $5,160.42 | $5,407.16 | $8,029.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,708.40 / $7,155.60 / $8,180.70
| Facility | | $5,708.40 | $7,155.60 | $8,180.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,567.99 / $8,085.83 / $10,515.96
| Facility | | $4,567.99 | $8,085.83 | $10,515.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,218.23 / $6,218.23 / $6,218.23
| Facility | | $6,218.23 | $6,218.23 | $6,218.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $6,484.63 / $9,986.49
| Facility | | $1,286.00 | $6,484.63 | $9,986.49 |