- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,928.93 / $8,180.98 / $13,692.10
| Facility | | $5,928.93 | $8,180.98 | $13,692.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,533.40 / $8,533.40 / $8,533.40
| Facility | | $8,533.40 | $8,533.40 | $8,533.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $9,143.21 / $13,836.10
| Facility | | $2,423.00 | $9,143.21 | $13,836.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,068.21 / $9,203.95 / $15,434.98
| Facility | | $6,068.21 | $9,203.95 | $15,434.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,428.10 / $16,517.25
| Facility | | $2,600.00 | $7,428.10 | $16,517.25 |