- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,363.37 / $11,128.30 / $14,927.70
| Facility | | $5,363.37 | $11,128.30 | $14,927.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,616.77 / $14,616.77 / $15,723.98
| Facility | | $14,616.77 | $14,616.77 | $15,723.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $12,518.48 / $14,885.05
| Facility | | $2,651.00 | $12,518.48 | $14,885.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,459.07 / $11,491.20 / $18,086.80
| Facility | | $9,459.07 | $11,491.20 | $18,086.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $14,197.08
| Facility | | $1,350.00 | $5,713.00 | $14,197.08 |