- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,718.22 / $9,789.71 / $13,132.10
| Facility | | $4,718.22 | $9,789.71 | $13,132.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,669.51 / $22,669.51 / $22,669.51
| Facility | | $22,669.51 | $22,669.51 | $22,669.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $8,054.95 / $9,577.70
| Facility | | $2,651.00 | $8,054.95 | $9,577.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,321.26 / $10,108.95 / $15,911.18
| Facility | | $8,321.26 | $10,108.95 | $15,911.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $12,489.34
| Facility | | $1,350.00 | $5,713.00 | $12,489.34 |