- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,766.24 / $7,814.48 / $10,482.40
| Facility | | $3,766.24 | $7,814.48 | $10,482.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,181.93 / $4,181.93 / $4,181.93
| Facility | | $4,181.93 | $4,181.93 | $4,181.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $8,022.58 / $9,539.21
| Facility | | $2,651.00 | $8,022.58 | $9,539.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,642.31 / $8,069.30 / $12,700.83
| Facility | | $6,642.31 | $8,069.30 | $12,700.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,468.00 / $9,969.41
| Facility | | $1,350.00 | $5,468.00 | $9,969.41 |