- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,605.36 / $10,494.20 / $17,563.59
| Facility | | $7,605.36 | $10,494.20 | $17,563.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,137.97 / $17,137.97 / $17,137.97
| Facility | | $17,137.97 | $17,137.97 | $17,137.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $11,881.30 / $18,299.13
| Facility | | $2,423.00 | $11,881.30 | $18,299.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,784.03 / $11,806.42 / $19,799.29
| Facility | | $7,784.03 | $11,806.42 | $19,799.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $9,528.43 / $21,187.57
| Facility | | $2,600.00 | $9,528.43 | $21,187.57 |