- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,118.65 / $16,845.20 / $22,596.40
| Facility | | $8,118.65 | $16,845.20 | $22,596.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,005.14 / $7,005.14 / $7,005.14
| Facility | | $7,005.14 | $7,005.14 | $7,005.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $11,043.31 / $13,131.01
| Facility | | $2,651.00 | $11,043.31 | $13,131.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,318.42 / $17,394.50 / $27,378.41
| Facility | | $14,318.42 | $17,394.50 | $27,378.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $21,490.45
| Facility | | $1,350.00 | $5,713.00 | $21,490.45 |