- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,733.29 / $9,821.00 / $13,174.00
| Facility | | $4,733.29 | $9,821.00 | $13,174.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,170.69 / $10,170.69 / $10,170.69
| Facility | | $10,170.69 | $10,170.69 | $10,170.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $9,264.46 / $11,015.88
| Facility | | $2,651.00 | $9,264.46 | $11,015.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,347.85 / $10,141.25 / $15,962.02
| Facility | | $8,347.85 | $10,141.25 | $15,962.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,888.00 / $12,770.50
| Facility | | $1,350.00 | $5,888.00 | $12,770.50 |