- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,662.78 / $8,974.28 / $14,899.40
| Facility | | $5,662.78 | $8,974.28 | $14,899.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,945.82 / $8,907.20 / $15,088.98
| Facility | | $5,945.82 | $8,907.20 | $15,088.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,358.54 / $9,470.00 / $13,499.00
| Facility | | $7,358.54 | $9,470.00 | $13,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,808.75 / $9,609.81 / $26,587.39
| Facility | | $4,808.75 | $9,609.81 | $26,587.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,808.75 / $9,226.00 / $12,895.14
| Facility | | $4,808.75 | $9,226.00 | $12,895.14 |