- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,837.14 / $6,674.49 / $11,170.70
| Facility | | $4,837.14 | $6,674.49 | $11,170.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,583.16 / $17,583.16 / $17,583.16
| Facility | | $17,583.16 | $17,583.16 | $17,583.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $7,988.65 / $12,539.08
| Facility | | $2,423.00 | $7,988.65 | $12,539.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,950.77 / $7,509.08 / $12,592.69
| Facility | | $4,950.77 | $7,509.08 | $12,592.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $6,060.25 / $13,475.66
| Facility | | $2,600.00 | $6,060.25 | $13,475.66 |