- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,381.72 / $15,316.20 / $20,545.30
| Facility | | $7,381.72 | $15,316.20 | $20,545.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,285.69 / $15,285.69 / $15,285.69
| Facility | | $15,285.69 | $15,285.69 | $15,285.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $18,769.82 / $22,318.19
| Facility | | $2,651.00 | $18,769.82 | $22,318.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,018.74 / $15,815.60 / $24,893.27
| Facility | | $13,018.74 | $15,815.60 | $24,893.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $19,539.75
| Facility | | $1,350.00 | $5,713.00 | $19,539.75 |