- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,852.57 / $10,068.50 / $13,506.00
| Facility | | $4,852.57 | $10,068.50 | $13,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,186.34 / $10,186.34 / $10,186.34
| Facility | | $10,186.34 | $10,186.34 | $10,186.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $10,212.78 / $12,143.47
| Facility | | $2,651.00 | $10,212.78 | $12,143.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,558.20 / $10,396.79 / $16,364.25
| Facility | | $8,558.20 | $10,396.79 | $16,364.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $12,844.97
| Facility | | $1,350.00 | $5,713.00 | $12,844.97 |