- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,090.54 / $12,637.10 / $16,951.59
| Facility | | $6,090.54 | $12,637.10 | $16,951.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,095.26 / $16,095.26 / $16,095.26
| Facility | | $16,095.26 | $16,095.26 | $16,095.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $11,869.08 / $14,112.89
| Facility | | $2,651.00 | $11,869.08 | $14,112.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,741.55 / $13,049.20 / $20,539.04
| Facility | | $10,741.55 | $13,049.20 | $20,539.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $16,121.94
| Facility | | $1,350.00 | $5,713.00 | $16,121.94 |