- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,332.54 / $12,589.25
| Facility | | $3,715.35 | $9,332.54 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,549.93 / $12,022.64
| Facility | | $7,585.78 | $9,549.93 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $9,332.54 / $10,471.29
| Facility | | $6,760.83 | $9,332.54 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,000.00 / $13,803.84
| Facility | | $7,943.28 | $10,000.00 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,165.95 / $12,302.69
| Facility | | $1,819.70 | $6,165.95 | $12,302.69 |