- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,729.88 / $7,739.04 / $10,381.20
| Facility | | $3,729.88 | $7,739.04 | $10,381.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,435.10 / $10,611.72 / $11,654.36
| Facility | | $8,435.10 | $10,611.72 | $11,654.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $7,489.60 / $8,905.48
| Facility | | $2,651.00 | $7,489.60 | $8,905.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,578.18 / $7,991.40 / $12,578.22
| Facility | | $6,578.18 | $7,991.40 | $12,578.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,468.00 / $9,873.16
| Facility | | $1,350.00 | $5,468.00 | $9,873.16 |