- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,292.18 / $5,922.54 / $9,912.23
| Facility | | $4,292.18 | $5,922.54 | $9,912.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,270.13 / $6,270.13 / $9,568.37
| Facility | | $6,270.13 | $6,270.13 | $9,568.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $6,790.81 / $10,238.83
| Facility | | $2,423.00 | $6,790.81 | $10,238.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.02 / $6,663.11 / $11,174.00
| Facility | | $4,393.02 | $6,663.11 | $11,174.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $5,377.50 / $11,957.50
| Facility | | $2,600.00 | $5,377.50 | $11,957.50 |