- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,493.90 / $8,340.93 / $13,847.90
| Facility | | $6,493.90 | $8,340.93 | $13,847.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,808.00 / $4,808.00 / $4,911.78
| Facility | | $4,808.00 | $4,808.00 | $4,911.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,709.22 / $7,209.08 / $12,060.36
| Facility | | $4,709.22 | $7,209.08 | $12,060.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,189.62 / $8,896.56 / $12,792.17
| Facility | | $7,189.62 | $8,896.56 | $12,792.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,469.38 / $8,931.60 / $21,057.81
| Facility | | $4,469.38 | $8,931.60 | $21,057.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,469.38 / $8,741.37 / $11,985.08
| Facility | | $4,469.38 | $8,741.37 | $11,985.08 |