- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,774.71 / $6,153.95 / $12,506.50
| Facility | | $4,774.71 | $6,153.95 | $12,506.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,374.20 / $4,374.20 / $4,374.20
| Facility | | $4,374.20 | $4,374.20 | $4,374.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.47 / $5,863.32 / $6,703.29
| Facility | | $4,677.47 | $5,863.32 | $6,703.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,811.24 / $6,746.29 / $8,773.84
| Facility | | $3,811.24 | $6,746.29 | $8,773.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $5,410.36 / $8,332.08
| Facility | | $1,286.00 | $5,410.36 | $8,332.08 |