- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,498.10 / $5,797.44 / $11,781.90
| Facility | | $4,498.10 | $5,797.44 | $11,781.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,085.30 / $4,085.30 / $4,085.30
| Facility | | $4,085.30 | $4,085.30 | $4,085.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,534.06 / $5,683.54 / $6,497.76
| Facility | | $4,534.06 | $5,683.54 | $6,497.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,590.44 / $6,355.46 / $8,265.54
| Facility | | $3,590.44 | $6,355.46 | $8,265.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,698.10 / $4,698.10 / $4,698.10
| Facility | | $4,698.10 | $4,698.10 | $4,698.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $5,096.92 / $7,849.39
| Facility | | $1,286.00 | $5,096.92 | $7,849.39 |