- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,389.26 / $5,321.65 / $6,135.54
| Facility | | $4,389.26 | $5,321.65 | $6,135.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,836.06 / $9,836.06 / $9,836.06
| Facility | | $9,836.06 | $9,836.06 | $9,836.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $2,554.00 / $3,843.00
| Facility | | $1,252.00 | $2,554.00 | $3,843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,904.56 / $6,214.98 / $10,666.85
| Facility | | $3,904.56 | $6,214.98 | $10,666.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,121.00 / $9,238.32
| Facility | | $2,332.00 | $5,121.00 | $9,238.32 |