- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,861.93 / $16,312.50 / $21,881.80
| Facility | | $7,861.93 | $16,312.50 | $21,881.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,343.81 / $16,343.81 / $16,343.81
| Facility | | $16,343.81 | $16,343.81 | $16,343.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $15,681.51 / $18,646.05
| Facility | | $2,651.00 | $15,681.51 | $18,646.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,865.64 / $16,844.45 / $26,512.65
| Facility | | $13,865.64 | $16,844.45 | $26,512.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $20,810.87
| Facility | | $1,350.00 | $5,713.00 | $20,810.87 |