- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,960.45 / $8,217.44 / $11,023.00
| Facility | | $3,960.45 | $8,217.44 | $11,023.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,264.42 / $9,727.95 / $12,909.32
| Facility | | $4,264.42 | $9,727.95 | $12,909.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $6,460.77 / $7,682.15
| Facility | | $2,651.00 | $6,460.77 | $7,682.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,984.82 / $8,485.40 / $13,355.76
| Facility | | $6,984.82 | $8,485.40 | $13,355.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,569.93 / $10,483.49
| Facility | | $1,350.00 | $5,569.93 | $10,483.49 |