- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,883.30 / $8,057.36 / $10,808.20
| Facility | | $3,883.30 | $8,057.36 | $10,808.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,215.00 / $8,845.20 / $12,363.24
| Facility | | $8,215.00 | $8,845.20 | $12,363.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $7,869.94 / $9,357.73
| Facility | | $2,651.00 | $7,869.94 | $9,357.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,848.76 / $8,320.10 / $13,095.58
| Facility | | $6,848.76 | $8,320.10 | $13,095.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,711.97 / $10,279.26
| Facility | | $1,350.00 | $5,711.97 | $10,279.26 |