- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,021.93 / $6,472.59 / $13,154.00
| Facility | | $5,021.93 | $6,472.59 | $13,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,255.17 / $6,255.17 / $6,255.17
| Facility | | $6,255.17 | $6,255.17 | $6,255.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,280.27 / $6,618.93 / $7,567.15
| Facility | | $5,280.27 | $6,618.93 | $7,567.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,008.58 / $7,095.60 / $9,228.12
| Facility | | $4,008.58 | $7,095.60 | $9,228.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,193.45 / $7,193.45 / $7,193.45
| Facility | | $7,193.45 | $7,193.45 | $7,193.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $5,690.50 / $8,763.50
| Facility | | $1,286.00 | $5,690.50 | $8,763.50 |