- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,613.00 / $11,646.30 / $15,622.50
| Facility | | $5,613.00 | $11,646.30 | $15,622.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,532.36 / $9,532.36 / $16,341.55
| Facility | | $9,532.36 | $9,532.36 | $16,341.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $10,200.51 / $12,128.88
| Facility | | $2,651.00 | $10,200.51 | $12,128.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,899.34 / $12,026.05 / $18,928.64
| Facility | | $9,899.34 | $12,026.05 | $18,928.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $14,857.87
| Facility | | $1,350.00 | $5,713.00 | $14,857.87 |