- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,536.00 / $6,258.96 / $10,475.29
| Facility | | $4,536.00 | $6,258.96 | $10,475.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,673.28 / $10,209.95 / $10,238.71
| Facility | | $6,673.28 | $10,209.95 | $10,238.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $7,226.44 / $10,856.88
| Facility | | $2,423.00 | $7,226.44 | $10,856.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,642.56 / $7,041.60 / $11,808.72
| Facility | | $4,642.56 | $7,041.60 | $11,808.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $5,682.96 / $12,636.72
| Facility | | $2,600.00 | $5,682.96 | $12,636.72 |