- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,978.51 / $9,629.24 / $16,115.90
| Facility | | $6,978.51 | $9,629.24 | $16,115.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,482.77 / $14,482.77 / $14,482.77
| Facility | | $14,482.77 | $14,482.77 | $14,482.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $11,242.60 / $17,058.43
| Facility | | $2,423.00 | $11,242.60 | $17,058.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,142.45 / $10,833.31 / $18,167.39
| Facility | | $7,142.45 | $10,833.31 | $18,167.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $8,743.08 / $19,441.24
| Facility | | $2,600.00 | $8,743.08 | $19,441.24 |