- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,018.98 / $8,338.87 / $11,185.90
| Facility | | $4,018.98 | $8,338.87 | $11,185.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,784.54 / $6,784.54 / $6,784.54
| Facility | | $6,784.54 | $6,784.54 | $6,784.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $6,699.04 / $7,965.46
| Facility | | $2,651.00 | $6,699.04 | $7,965.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,088.05 / $8,610.79 / $13,553.14
| Facility | | $7,088.05 | $8,610.79 | $13,553.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,665.68 / $10,638.42
| Facility | | $1,350.00 | $5,665.68 | $10,638.42 |