- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,530.36 / $8,610.37 / $14,295.20
| Facility | | $5,530.36 | $8,610.37 | $14,295.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.00 / $6,456.00 / $6,456.00
| Facility | | $6,456.00 | $6,456.00 | $6,456.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,949.87 / $7,415.20 / $12,561.50
| Facility | | $4,949.87 | $7,415.20 | $12,561.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,421.86 / $9,183.95 / $13,205.39
| Facility | | $7,421.86 | $9,183.95 | $13,205.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.75 / $9,220.12 / $22,133.87
| Facility | | $4,613.75 | $9,220.12 | $22,133.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.75 / $9,023.76 / $12,372.23
| Facility | | $4,613.75 | $9,023.76 | $12,372.23 |