- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,068.79 / $8,373.96 / $14,015.10
| Facility | | $6,068.79 | $8,373.96 | $14,015.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,974.96 / $15,974.96 / $15,974.96
| Facility | | $15,974.96 | $15,974.96 | $15,974.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $9,681.70 / $14,613.49
| Facility | | $2,423.00 | $9,681.70 | $14,613.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,211.36 / $9,421.07 / $15,799.08
| Facility | | $6,211.36 | $9,421.07 | $15,799.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,603.33 / $16,906.88
| Facility | | $2,600.00 | $7,603.33 | $16,906.88 |