- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.36 / $7,414.28 / $9,945.61
| Facility | | $3,573.36 | $7,414.28 | $9,945.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,171.54 / $9,865.70 / $22,338.07
| Facility | | $7,171.54 | $9,865.70 | $22,338.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $7,672.44 / $9,122.89
| Facility | | $2,651.00 | $7,672.44 | $9,122.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,302.14 / $7,656.05 / $12,050.39
| Facility | | $6,302.14 | $7,656.05 | $12,050.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,372.00 / $9,458.85
| Facility | | $1,350.00 | $5,372.00 | $9,458.85 |