- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,913.56 / $5,400.09 / $9,037.84
| Facility | | $3,913.56 | $5,400.09 | $9,037.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,865.34 / $8,865.34 / $8,865.34
| Facility | | $8,865.34 | $8,865.34 | $8,865.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $6,350.75 / $9,515.54
| Facility | | $2,423.00 | $6,350.75 | $9,515.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,005.50 / $6,075.34 / $10,188.29
| Facility | | $4,005.50 | $6,075.34 | $10,188.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $4,903.13 / $10,902.68
| Facility | | $2,600.00 | $4,903.13 | $10,902.68 |