- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,306.30 / $8,935.04 / $11,985.60
| Facility | | $4,306.30 | $8,935.04 | $11,985.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,495.69 / $8,159.86 / $13,008.54
| Facility | | $6,495.69 | $8,159.86 | $13,008.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $7,028.27 / $8,356.95
| Facility | | $2,651.00 | $7,028.27 | $8,356.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,594.78 / $9,226.40 / $14,522.07
| Facility | | $7,594.78 | $9,226.40 | $14,522.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,888.00 / $13,107.32
| Facility | | $1,500.00 | $5,888.00 | $13,107.32 |