- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,911.54 / $10,190.79 / $13,670.10
| Facility | | $4,911.54 | $10,190.79 | $13,670.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,596.51 / $9,782.65 / $12,326.02
| Facility | | $5,596.51 | $9,782.65 | $12,326.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $10,779.95 / $12,817.86
| Facility | | $2,651.00 | $10,779.95 | $12,817.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,662.20 / $10,523.15 / $16,563.12
| Facility | | $8,662.20 | $10,523.15 | $16,563.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $13,001.07
| Facility | | $1,350.00 | $5,713.00 | $13,001.07 |