- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,352.73 / $11,106.20 / $14,898.10
| Facility | | $5,352.73 | $11,106.20 | $14,898.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,696.40 / $15,696.40 / $15,696.40
| Facility | | $15,696.40 | $15,696.40 | $15,696.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $14,594.88 / $17,353.99
| Facility | | $2,651.00 | $14,594.88 | $17,353.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,440.29 / $11,468.40 / $18,050.91
| Facility | | $9,440.29 | $11,468.40 | $18,050.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $14,168.91
| Facility | | $1,350.00 | $5,713.00 | $14,168.91 |