- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,763.06 / $7,394.98 / $12,277.40
| Facility | | $5,763.06 | $7,394.98 | $12,277.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,899.10 / $7,499.74 / $12,432.66
| Facility | | $4,899.10 | $7,499.74 | $12,432.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,417.98 / $8,000.00 / $11,534.00
| Facility | | $6,417.98 | $8,000.00 | $11,534.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,962.50 / $7,950.99 / $21,906.84
| Facility | | $3,962.50 | $7,950.99 | $21,906.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,962.50 / $7,750.02 / $10,625.84
| Facility | | $3,962.50 | $7,750.02 | $10,625.84 |