- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,444.90 / $8,892.94 / $14,883.60
| Facility | | $6,444.90 | $8,892.94 | $14,883.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,979.75 / $9,979.75 / $14,641.31
| Facility | | $9,979.75 | $9,979.75 | $14,641.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $10,270.23 / $16,078.94
| Facility | | $2,423.00 | $10,270.23 | $16,078.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,596.30 / $10,004.94 / $16,778.22
| Facility | | $6,596.30 | $10,004.94 | $16,778.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $8,074.54 / $17,954.66
| Facility | | $2,600.00 | $8,074.54 | $17,954.66 |