- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,305.91 / $7,558.97 / $12,170.90
| Facility | | $3,305.91 | $7,558.97 | $12,170.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,665.32 / $5,665.32 / $5,665.32
| Facility | | $5,665.32 | $5,665.32 | $5,665.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $5,820.01 / $10,615.73
| Facility | | $1,474.01 | $5,820.01 | $10,615.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,471.72 / $7,903.39 / $11,196.10
| Facility | | $5,471.72 | $7,903.39 | $11,196.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,782.89 / $6,628.79 / $16,080.00
| Facility | | $4,782.89 | $6,628.79 | $16,080.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,490.63 / $6,628.79 / $14,101.03
| Facility | | $4,490.63 | $6,628.79 | $14,101.03 |