- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,327.58 / $8,979.20 / $12,044.80
| Facility | | $4,327.58 | $8,979.20 | $12,044.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,868.40 / $12,519.52 / $12,933.95
| Facility | | $11,868.40 | $12,519.52 | $12,933.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $12,420.46 / $14,768.51
| Facility | | $2,651.00 | $12,420.46 | $14,768.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,632.32 / $9,272.00 / $14,593.84
| Facility | | $7,632.32 | $9,272.00 | $14,593.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $11,455.31
| Facility | | $1,350.00 | $5,713.00 | $11,455.31 |