- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,759.63 / $14,025.40 / $18,813.90
| Facility | | $6,759.63 | $14,025.40 | $18,813.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,858.09 / $24,858.09 / $24,858.09
| Facility | | $24,858.09 | $24,858.09 | $24,858.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $14,840.19 / $17,645.66
| Facility | | $3,897.00 | $14,840.19 | $17,645.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,921.59 / $14,482.75 / $22,795.41
| Facility | | $11,921.59 | $14,482.75 | $22,795.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $17,893.06 / $22,597.66
| Facility | | $1,350.00 | $17,893.06 | $22,597.66 |