- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,916.70 / $9,376.69 / $15,567.50
| Facility | | $5,916.70 | $9,376.69 | $15,567.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,988.00 / $2,988.00 / $2,988.00
| Facility | | $2,988.00 | $2,988.00 | $2,988.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,686.40 / $8,704.98 / $14,430.64
| Facility | | $5,686.40 | $8,704.98 | $14,430.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,324.33 / $9,550.33 / $14,380.68
| Facility | | $7,324.33 | $9,550.33 | $14,380.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,024.38 / $10,040.70 / $25,427.36
| Facility | | $5,024.38 | $10,040.70 | $25,427.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,605.03 / $9,586.51 / $13,473.36
| Facility | | $6,605.03 | $9,586.51 | $13,473.36 |