- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,744.88 / $7,371.65 / $12,238.70
| Facility | | $5,744.88 | $7,371.65 | $12,238.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,570.08 / $7,570.08 / $7,570.08
| Facility | | $7,570.08 | $7,570.08 | $7,570.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.12 / $7,020.63 / $11,696.64
| Facility | | $4,586.12 | $7,020.63 | $11,696.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,354.13 / $7,930.00 / $11,697.00
| Facility | | $6,354.13 | $7,930.00 | $11,697.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,952.00 / $7,925.91 / $20,507.34
| Facility | | $3,952.00 | $7,925.91 | $20,507.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,952.00 / $7,725.57 / $10,592.32
| Facility | | $3,952.00 | $7,725.57 | $10,592.32 |