- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,502.05 / $7,091.40 / $14,411.60
| Facility | | $5,502.05 | $7,091.40 | $14,411.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,872.21 / $8,872.21 / $8,872.21
| Facility | | $8,872.21 | $8,872.21 | $8,872.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,662.25 / $7,097.75 / $8,114.56
| Facility | | $5,662.25 | $7,097.75 | $8,114.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,391.82 / $7,773.98 / $10,110.39
| Facility | | $4,391.82 | $7,773.98 | $10,110.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,203.04 / $10,203.04 / $10,203.04
| Facility | | $10,203.04 | $10,203.04 | $10,203.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $6,234.54 / $9,601.34
| Facility | | $1,286.00 | $6,234.54 | $9,601.34 |