- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,271.27 / $8,862.36 / $11,888.10
| Facility | | $4,271.27 | $8,862.36 | $11,888.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,904.62 / $11,904.62 / $11,904.62
| Facility | | $11,904.62 | $11,904.62 | $11,904.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $9,831.07 / $11,689.60
| Facility | | $2,651.00 | $9,831.07 | $11,689.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,533.01 / $9,151.35 / $14,403.95
| Facility | | $7,533.01 | $9,151.35 | $14,403.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $11,306.25
| Facility | | $1,350.00 | $5,713.00 | $11,306.25 |