- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,861.57 / $8,012.28 / $10,747.80
| Facility | | $3,861.57 | $8,012.28 | $10,747.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,226.89 / $8,235.45 / $19,376.59
| Facility | | $4,226.89 | $8,235.45 | $19,376.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $6,744.46 / $8,019.48
| Facility | | $2,651.00 | $6,744.46 | $8,019.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,810.44 / $8,273.54 / $13,022.32
| Facility | | $6,810.44 | $8,273.54 | $13,022.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,609.88 / $10,221.75
| Facility | | $1,350.00 | $5,609.88 | $10,221.75 |