- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,015.30 / $10,406.10 / $13,958.90
| Facility | | $5,015.30 | $10,406.10 | $13,958.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,616.52 / $8,616.52 / $8,616.52
| Facility | | $8,616.52 | $8,616.52 | $8,616.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $9,865.48 / $11,730.51
| Facility | | $2,651.00 | $9,865.48 | $11,730.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,845.20 / $10,745.45 / $16,913.00
| Facility | | $8,845.20 | $10,745.45 | $16,913.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $13,275.72
| Facility | | $1,350.00 | $5,713.00 | $13,275.72 |