- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,914.82 / $5,401.83 / $9,040.75
| Facility | | $3,914.82 | $5,401.83 | $9,040.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,904.98 / $8,904.98 / $8,904.98
| Facility | | $8,904.98 | $8,904.98 | $8,904.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $6,064.89 / $9,370.09
| Facility | | $2,423.00 | $6,064.89 | $9,370.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,006.79 / $6,077.29 / $10,191.58
| Facility | | $4,006.79 | $6,077.29 | $10,191.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $4,904.71 / $10,906.19
| Facility | | $2,600.00 | $4,904.71 | $10,906.19 |