- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,987.10 / $14,497.40 / $19,446.90
| Facility | | $6,987.10 | $14,497.40 | $19,446.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,575.25 / $19,575.25 / $19,575.25
| Facility | | $19,575.25 | $19,575.25 | $19,575.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $14,628.38 / $17,393.82
| Facility | | $2,651.00 | $14,628.38 | $17,393.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,322.76 / $14,970.10 / $23,562.48
| Facility | | $12,322.76 | $14,970.10 | $23,562.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,888.00 / $18,495.16
| Facility | | $1,350.00 | $5,888.00 | $18,495.16 |