- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,232.78 / $7,220.41 / $12,084.40
| Facility | | $5,232.78 | $7,220.41 | $12,084.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,665.04 / $6,665.04 / $6,665.04
| Facility | | $6,665.04 | $6,665.04 | $6,665.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $8,050.69 / $12,472.04
| Facility | | $2,423.00 | $8,050.69 | $12,472.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,355.71 / $8,123.27 / $13,622.67
| Facility | | $5,355.71 | $8,123.27 | $13,622.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,160.00 / $5,584.12 / $14,286.32
| Facility | | $2,160.00 | $5,584.12 | $14,286.32 |