- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,490.54 / $7,981.12 / $12,850.60
| Facility | | $3,490.54 | $7,981.12 | $12,850.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,359.14 / $12,359.14 / $12,359.14
| Facility | | $12,359.14 | $12,359.14 | $12,359.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $4,713.02 / $10,965.29
| Facility | | $1,474.01 | $4,713.02 | $10,965.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,777.30 / $8,344.77 / $11,821.37
| Facility | | $5,777.30 | $8,344.77 | $11,821.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,050.00 / $6,998.99 / $14,698.74
| Facility | | $5,050.00 | $6,998.99 | $14,698.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,741.42 / $6,998.99 / $14,888.53
| Facility | | $4,741.42 | $6,998.99 | $14,888.53 |