- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,257.53 / $8,833.84 / $11,849.80
| Facility | | $4,257.53 | $8,833.84 | $11,849.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,962.93 / $12,902.83 / $23,334.29
| Facility | | $8,962.93 | $12,902.83 | $23,334.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.00 / $850.00 / $850.00
| Facility | | $850.00 | $850.00 | $850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,508.76 / $11,076.87 / $12,434.59
| Facility | | $7,508.76 | $11,076.87 | $12,434.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $11,269.87
| Facility | | $1,350.00 | $5,713.00 | $11,269.87 |