- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,737.86 / $7,755.60 / $10,403.50
| Facility | | $3,737.86 | $7,755.60 | $10,403.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,688.47 / $7,688.47 / $10,293.48
| Facility | | $7,688.47 | $7,688.47 | $10,293.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $8,902.07 / $10,584.97
| Facility | | $2,651.00 | $8,902.07 | $10,584.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,592.26 / $8,008.50 / $12,605.13
| Facility | | $6,592.26 | $8,008.50 | $12,605.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,563.80 / $9,894.29
| Facility | | $1,350.00 | $5,563.80 | $9,894.29 |