- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,801.22 / $6,188.12 / $12,575.90
| Facility | | $4,801.22 | $6,188.12 | $12,575.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,148.37 / $6,148.37 / $6,148.37
| Facility | | $6,148.37 | $6,148.37 | $6,148.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,933.79 / $6,184.61 / $7,070.61
| Facility | | $4,933.79 | $6,184.61 | $7,070.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,832.40 / $6,783.75 / $8,822.56
| Facility | | $3,832.40 | $6,783.75 | $8,822.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,070.63 / $7,070.63 / $7,070.63
| Facility | | $7,070.63 | $7,070.63 | $7,070.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $5,440.40 / $8,378.35
| Facility | | $1,286.00 | $5,440.40 | $8,378.35 |