- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,773.95 / $7,967.13 / $13,334.20
| Facility | | $5,773.95 | $7,967.13 | $13,334.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $9,205.29 / $14,177.65
| Facility | | $2,423.00 | $9,205.29 | $14,177.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.64 / $106.64 / $106.64
| Facility | | $106.64 | $106.64 | $106.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,909.59 / $8,963.37 / $15,031.52
| Facility | | $5,909.59 | $8,963.37 | $15,031.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,233.93 / $16,085.49
| Facility | | $2,600.00 | $7,233.93 | $16,085.49 |