- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,645.80 / $7,956.01 / $13,208.90
| Facility | | $5,645.80 | $7,956.01 | $13,208.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,204.47 / $5,204.47 / $6,539.57
| Facility | | $5,204.47 | $5,204.47 | $6,539.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,748.17 / $7,268.70 / $12,049.65
| Facility | | $4,748.17 | $7,268.70 | $12,049.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,904.90 / $8,486.01 / $12,201.84
| Facility | | $6,904.90 | $8,486.01 | $12,201.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,263.13 / $8,554.21 / $21,231.97
| Facility | | $4,263.13 | $8,554.21 | $21,231.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,263.13 / $8,337.99 / $11,432.00
| Facility | | $4,263.13 | $8,337.99 | $11,432.00 |