- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,172.84 / $8,658.12 / $11,614.10
| Facility | | $4,172.84 | $8,658.12 | $11,614.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,974.20 / $3,974.20 / $3,974.20
| Facility | | $3,974.20 | $3,974.20 | $3,974.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $8,333.31 / $9,908.69
| Facility | | $2,651.00 | $8,333.31 | $9,908.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,359.40 / $8,940.45 / $14,072.00
| Facility | | $7,359.40 | $8,940.45 | $14,072.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,792.50 / $11,045.69
| Facility | | $1,350.00 | $5,792.50 | $11,045.69 |