- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,660.62 / $15,894.80 / $21,321.50
| Facility | | $7,660.62 | $15,894.80 | $21,321.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,204.76 / $29,204.76 / $29,204.76
| Facility | | $29,204.76 | $29,204.76 | $29,204.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $19,823.98 / $23,571.63
| Facility | | $3,897.00 | $19,823.98 | $23,571.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,510.61 / $16,413.15 / $25,833.80
| Facility | | $13,510.61 | $16,413.15 | $25,833.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $20,288.38 / $29,094.47
| Facility | | $1,350.00 | $20,288.38 | $29,094.47 |