- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,299.56 / $7,312.55 / $12,238.60
| Facility | | $5,299.56 | $7,312.55 | $12,238.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,046.46 / $8,046.46 / $8,046.46
| Facility | | $8,046.46 | $8,046.46 | $8,046.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $8,481.57 / $13,063.00
| Facility | | $2,423.00 | $8,481.57 | $13,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,424.06 / $8,226.94 / $13,796.52
| Facility | | $5,424.06 | $8,226.94 | $13,796.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $6,639.59 / $14,763.90
| Facility | | $2,600.00 | $6,639.59 | $14,763.90 |