- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,058.62 / $12,570.90 / $16,862.70
| Facility | | $6,058.62 | $12,570.90 | $16,862.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,201.55 / $15,201.55 / $15,201.55
| Facility | | $15,201.55 | $15,201.55 | $15,201.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $12,043.75 / $14,320.58
| Facility | | $3,897.00 | $12,043.75 | $14,320.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,685.25 / $12,980.80 / $20,431.38
| Facility | | $10,685.25 | $12,980.80 | $20,431.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $16,037.44 / $20,254.15
| Facility | | $1,350.00 | $16,037.44 | $20,254.15 |