- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,442.08 / $5,385.68 / $6,209.37
| Facility | | $4,442.08 | $5,385.68 | $6,209.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,104.64 / $11,104.64 / $11,104.64
| Facility | | $11,104.64 | $11,104.64 | $11,104.64 |
- 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
- $3,951.54 / $6,289.76 / $10,795.20
| Facility | | $3,951.54 | $6,289.76 | $10,795.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,044.00 / $9,349.48
| Facility | | $2,332.00 | $5,044.00 | $9,349.48 |