- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,784.66 / $7,981.91 / $13,358.90
| Facility | | $5,784.66 | $7,981.91 | $13,358.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,524.77 / $12,524.77 / $15,621.48
| Facility | | $12,524.77 | $12,524.77 | $15,621.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $9,015.11 / $14,015.16
| Facility | | $2,423.00 | $9,015.11 | $14,015.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,920.55 / $8,980.00 / $15,059.40
| Facility | | $5,920.55 | $8,980.00 | $15,059.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,247.35 / $16,115.33
| Facility | | $2,600.00 | $7,247.35 | $16,115.33 |