- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,075.29 / $8,455.71 / $11,342.60
| Facility | | $4,075.29 | $8,455.71 | $11,342.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,618.82 / $8,618.82 / $8,618.82
| Facility | | $8,618.82 | $8,618.82 | $8,618.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $9,564.18 / $11,372.25
| Facility | | $2,651.00 | $9,564.18 | $11,372.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,187.36 / $8,731.45 / $13,743.04
| Facility | | $7,187.36 | $8,731.45 | $13,743.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,789.33 / $10,995.19
| Facility | | $1,350.00 | $5,789.33 | $10,995.19 |