- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,731.74 / $7,908.89 / $13,236.70
| Facility | | $5,731.74 | $7,908.89 | $13,236.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,093.30 / $13,093.30 / $13,093.30
| Facility | | $13,093.30 | $13,093.30 | $13,093.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $9,273.33 / $14,282.43
| Facility | | $2,423.00 | $9,273.33 | $14,282.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,866.39 / $8,897.84 / $14,921.63
| Facility | | $5,866.39 | $8,897.84 | $14,921.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,181.05 / $15,967.90
| Facility | | $2,600.00 | $7,181.05 | $15,967.90 |