- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,793.54 / $12,133.70 / $20,307.50
| Facility | | $8,793.54 | $12,133.70 | $20,307.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,045.49 / $18,045.49 / $18,045.49
| Facility | | $18,045.49 | $18,045.49 | $18,045.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $13,576.21 / $21,113.10
| Facility | | $2,423.00 | $13,576.21 | $21,113.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,000.12 / $13,650.92 / $22,892.52
| Facility | | $9,000.12 | $13,650.92 | $22,892.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $11,017.05 / $24,577.25
| Facility | | $2,600.00 | $11,017.05 | $24,577.25 |