- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,021.54 / $8,308.77 / $13,905.90
| Facility | | $6,021.54 | $8,308.77 | $13,905.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,966.97 / $16,966.97 / $16,966.97
| Facility | | $16,966.97 | $16,966.97 | $16,966.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $9,249.29 / $14,517.82
| Facility | | $2,423.00 | $9,249.29 | $14,517.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,163.00 / $9,347.71 / $15,676.08
| Facility | | $6,163.00 | $9,347.71 | $15,676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,544.13 / $16,829.73
| Facility | | $2,600.00 | $7,544.13 | $16,829.73 |