- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,532.88 / $9,405.16 / $12,616.20
| Facility | | $4,532.88 | $9,405.16 | $12,616.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,656.08 / $13,656.08 / $13,656.08
| Facility | | $13,656.08 | $13,656.08 | $13,656.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $14,712.53 / $17,493.89
| Facility | | $3,897.00 | $14,712.53 | $17,493.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,994.39 / $9,711.85 / $15,286.16
| Facility | | $7,994.39 | $9,711.85 | $15,286.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $11,998.74 / $15,153.55
| Facility | | $1,350.00 | $11,998.74 | $15,153.55 |