- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,787.20 / $8,659.44 / $13,942.80
| Facility | | $3,787.20 | $8,659.44 | $13,942.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.25 / $7,546.98 / $8,728.25
| Facility | | $5,011.25 | $7,546.98 | $8,728.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $5,660.08 / $12,278.68
| Facility | | $1,474.01 | $5,660.08 | $12,278.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,268.32 / $9,419.04 / $13,910.11
| Facility | | $6,268.32 | $9,419.04 | $13,910.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,144.39 / $9,264.95 / $15,948.00
| Facility | | $5,144.39 | $9,264.95 | $15,948.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,144.39 / $9,264.95 / $13,690.80
| Facility | | $5,144.39 | $9,264.95 | $13,690.80 |