- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,399.73 / $7,450.77 / $12,469.90
| Facility | | $5,399.73 | $7,450.77 | $12,469.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,274.71 / $8,274.71 / $15,976.35
| Facility | | $8,274.71 | $8,274.71 | $15,976.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $8,616.75 / $13,430.50
| Facility | | $2,423.00 | $8,616.75 | $13,430.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,526.58 / $8,382.44 / $14,057.30
| Facility | | $5,526.58 | $8,382.44 | $14,057.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $6,765.09 / $15,042.96
| Facility | | $2,600.00 | $6,765.09 | $15,042.96 |