- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,086.62 / $7,018.73 / $11,746.90
| Facility | | $5,086.62 | $7,018.73 | $11,746.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,068.31 / $11,068.31 / $11,068.31
| Facility | | $11,068.31 | $11,068.31 | $11,068.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $8,215.23 / $12,314.33
| Facility | | $2,423.00 | $8,215.23 | $12,314.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,206.12 / $7,896.37 / $13,242.17
| Facility | | $5,206.12 | $7,896.37 | $13,242.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $6,372.81 / $14,170.68
| Facility | | $2,600.00 | $6,372.81 | $14,170.68 |