- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,928.43 / $7,640.94 / $15,528.40
| Facility | | $5,928.43 | $7,640.94 | $15,528.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,613.92 / $5,613.92 / $5,613.92
| Facility | | $5,613.92 | $5,613.92 | $5,613.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,690.65 / $7,133.35 / $8,155.26
| Facility | | $5,690.65 | $7,133.35 | $8,155.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,732.16 / $8,376.41 / $10,893.89
| Facility | | $4,732.16 | $8,376.41 | $10,893.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.01 / $6,456.01 / $9,618.43
| Facility | | $6,456.01 | $6,456.01 | $9,618.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $6,717.68 / $10,345.39
| Facility | | $1,286.00 | $6,717.68 | $10,345.39 |