- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,627.16 / $7,764.59 / $12,995.20
| Facility | | $5,627.16 | $7,764.59 | $12,995.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,837.37 / $16,837.37 / $16,837.37
| Facility | | $16,837.37 | $16,837.37 | $16,837.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $8,517.07 / $13,194.55
| Facility | | $2,423.00 | $8,517.07 | $13,194.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,759.35 / $8,735.50 / $14,649.37
| Facility | | $5,759.35 | $8,735.50 | $14,649.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,050.03 / $15,676.55
| Facility | | $2,600.00 | $7,050.03 | $15,676.55 |