- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,095.90 / $6,360.00 / $10,317.10
| Facility | | $4,095.90 | $6,360.00 | $10,317.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,372.00 / $6,904.65
| Facility | | $688.00 | $2,372.00 | $6,904.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,095.90 / $6,402.00 / $11,996.44
| Facility | | $4,095.90 | $6,402.00 | $11,996.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,392.29 / $13,736.87 / $13,736.87
| Facility | | $8,392.29 | $13,736.87 | $13,736.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,095.90 / $5,941.33 / $13,120.99
| Facility | | $4,095.90 | $5,941.33 | $13,120.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,378.81 / $5,108.04 / $11,653.29
| Facility | | $2,378.81 | $5,108.04 | $11,653.29 |