- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,671.84 / $13,843.20 / $18,569.50
| Facility | | $6,671.84 | $13,843.20 | $18,569.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,579.17 / $14,579.17 / $14,579.17
| Facility | | $14,579.17 | $14,579.17 | $14,579.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $18,593.45 / $22,108.47
| Facility | | $3,897.00 | $18,593.45 | $22,108.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.75 / $14,294.65 / $22,499.34
| Facility | | $11,766.75 | $14,294.65 | $22,499.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $17,660.66 / $22,304.17
| Facility | | $1,350.00 | $17,660.66 | $22,304.17 |