- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,491.08 / $7,576.82 / $12,680.90
| Facility | | $5,491.08 | $7,576.82 | $12,680.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,554.32 / $16,554.32 / $16,554.32
| Facility | | $16,554.32 | $16,554.32 | $16,554.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $8,751.34 / $13,231.56
| Facility | | $2,423.00 | $8,751.34 | $13,231.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,620.08 / $8,524.25 / $14,295.11
| Facility | | $5,620.08 | $8,524.25 | $14,295.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $6,879.54 / $15,297.45
| Facility | | $2,600.00 | $6,879.54 | $15,297.45 |