- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,486.67 / $7,570.73 / $12,670.70
| Facility | | $5,486.67 | $7,570.73 | $12,670.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,239.18 / $9,775.37 / $16,640.64
| Facility | | $8,239.18 | $9,775.37 | $16,640.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $8,685.67 / $13,377.35
| Facility | | $2,423.00 | $8,685.67 | $13,377.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,615.56 / $8,517.40 / $14,283.63
| Facility | | $5,615.56 | $8,517.40 | $14,283.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $6,874.01 / $15,285.17
| Facility | | $2,600.00 | $6,874.01 | $15,285.17 |