- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,289.94 / $6,818.02 / $13,856.00
| Facility | | $5,289.94 | $6,818.02 | $13,856.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,730.07 / $4,730.07 / $7,244.93
| Facility | | $4,730.07 | $4,730.07 | $7,244.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,217.08 / $6,539.72 / $7,476.59
| Facility | | $5,217.08 | $6,539.72 | $7,476.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,222.50 / $7,474.28 / $9,720.62
| Facility | | $4,222.50 | $7,474.28 | $9,720.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,331.67 / $8,331.67 / $8,331.67
| Facility | | $8,331.67 | $8,331.67 | $8,331.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $5,994.18 / $9,231.19
| Facility | | $1,286.00 | $5,994.18 | $9,231.19 |