- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,530.79 / $7,325.96 / $9,827.14
| Facility | | $3,530.79 | $7,325.96 | $9,827.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,793.15 / $9,793.15 / $10,105.01
| Facility | | $9,793.15 | $9,793.15 | $10,105.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $7,873.92 / $9,362.45
| Facility | | $2,651.00 | $7,873.92 | $9,362.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,227.07 / $7,564.85 / $11,906.84
| Facility | | $6,227.07 | $7,564.85 | $11,906.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,372.00 / $9,346.17
| Facility | | $1,350.00 | $5,372.00 | $9,346.17 |