- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,192.48 / $6,624.00 / $8,885.52
| Facility | | $3,192.48 | $6,624.00 | $8,885.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,071.48 / $5,707.71 / $9,022.45
| Facility | | $3,071.48 | $5,707.71 | $9,022.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $9,816.42 / $11,672.18
| Facility | | $2,651.00 | $9,816.42 | $11,672.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,630.40 / $6,840.00 / $10,765.95
| Facility | | $5,630.40 | $6,840.00 | $10,765.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,468.00 / $8,613.36
| Facility | | $1,350.00 | $5,468.00 | $8,613.36 |