- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,569.37 / $7,406.00 / $9,934.50
| Facility | | $3,569.37 | $7,406.00 | $9,934.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,777.43 / $8,777.43 / $10,776.47
| Facility | | $8,777.43 | $8,777.43 | $10,776.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $7,907.42 / $9,402.29
| Facility | | $2,651.00 | $7,907.42 | $9,402.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,295.10 / $7,647.50 / $12,036.93
| Facility | | $6,295.10 | $7,647.50 | $12,036.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,372.00 / $9,448.29
| Facility | | $1,350.00 | $5,372.00 | $9,448.29 |