- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,887.93 / $6,299.88 / $12,803.00
| Facility | | $4,887.93 | $6,299.88 | $12,803.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,469.11 / $6,469.11 / $7,148.07
| Facility | | $6,469.11 | $6,469.11 | $7,148.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,918.17 / $6,165.03 / $7,048.22
| Facility | | $4,918.17 | $6,165.03 | $7,048.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,901.61 / $6,906.26 / $8,981.89
| Facility | | $3,901.61 | $6,906.26 | $8,981.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,439.48 / $7,439.48 / $8,220.28
| Facility | | $7,439.48 | $7,439.48 | $8,220.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $5,538.65 / $8,529.66
| Facility | | $1,286.00 | $5,538.65 | $8,529.66 |