- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,119.85 / $7,546.57 / $10,685.10
| Facility | | $4,119.85 | $7,546.57 | $10,685.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,263.36 / $7,263.36 / $7,263.36
| Facility | | $7,263.36 | $7,263.36 | $7,263.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,646.64 / $7,581.15 / $12,233.20
| Facility | | $4,646.64 | $7,581.15 | $12,233.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,283.39 / $6,788.54 / $12,077.89
| Facility | | $4,283.39 | $6,788.54 | $12,077.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $6,610.23 / $14,282.13
| Facility | | $3,308.00 | $6,610.23 | $14,282.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $6,783.96 / $12,691.84
| Facility | | $3,000.00 | $6,783.96 | $12,691.84 |