- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,783.58 / $14,075.10 / $18,880.50
| Facility | | $6,783.58 | $14,075.10 | $18,880.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,643.40 / $17,643.40 / $17,643.40
| Facility | | $17,643.40 | $17,643.40 | $17,643.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $11,530.98 / $13,710.88
| Facility | | $2,651.00 | $11,530.98 | $13,710.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,963.82 / $14,534.05 / $22,876.15
| Facility | | $11,963.82 | $14,534.05 | $22,876.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $17,956.43
| Facility | | $1,350.00 | $5,713.00 | $17,956.43 |