- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,894.91 / $8,134.04 / $13,613.50
| Facility | | $5,894.91 | $8,134.04 | $13,613.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,532.42 / $12,532.42 / $12,532.42
| Facility | | $12,532.42 | $12,532.42 | $12,532.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $9,454.42 / $14,294.58
| Facility | | $2,423.00 | $9,454.42 | $14,294.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,033.39 / $9,151.15 / $15,346.42
| Facility | | $6,033.39 | $9,151.15 | $15,346.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,385.48 / $16,422.47
| Facility | | $2,600.00 | $7,385.48 | $16,422.47 |