- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,239.39 / $15,020.80 / $20,149.20
| Facility | | $7,239.39 | $15,020.80 | $20,149.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,265.73 / $15,265.73 / $17,622.71
| Facility | | $15,265.73 | $15,265.73 | $17,622.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $13,226.24 / $15,726.62
| Facility | | $2,651.00 | $13,226.24 | $15,726.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,767.71 / $15,510.65 / $24,413.29
| Facility | | $12,767.71 | $15,510.65 | $24,413.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,888.00 / $19,163.00
| Facility | | $1,350.00 | $5,888.00 | $19,163.00 |