- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,450.54 / $7,159.44 / $9,603.77
| Facility | | $3,450.54 | $7,159.44 | $9,603.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,528.33 / $9,065.37 / $11,764.77
| Facility | | $3,528.33 | $9,065.37 | $11,764.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $4,948.58 / $5,884.09
| Facility | | $2,651.00 | $4,948.58 | $5,884.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,085.52 / $7,392.90 / $11,636.20
| Facility | | $6,085.52 | $7,392.90 | $11,636.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,372.00 / $9,133.73
| Facility | | $1,350.00 | $5,372.00 | $9,133.73 |