- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,463.80 / $8,919.02 / $14,927.30
| Facility | | $6,463.80 | $8,919.02 | $14,927.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,085.70 / $10,085.70 / $10,085.70
| Facility | | $10,085.70 | $10,085.70 | $10,085.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $10,390.46 / $16,003.01
| Facility | | $2,423.00 | $10,390.46 | $16,003.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,615.65 / $10,034.28 / $16,827.43
| Facility | | $6,615.65 | $10,034.28 | $16,827.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $8,098.22 / $18,007.33
| Facility | | $2,600.00 | $8,098.22 | $18,007.33 |