- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,711.30 / $13,925.10 / $18,679.30
| Facility | | $6,711.30 | $13,925.10 | $18,679.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,527.85 / $24,527.85 / $24,527.85
| Facility | | $24,527.85 | $24,527.85 | $24,527.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $15,626.77 / $18,580.96
| Facility | | $3,897.00 | $15,626.77 | $18,580.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,836.35 / $14,379.20 / $22,632.42
| Facility | | $11,836.35 | $14,379.20 | $22,632.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $17,765.12 / $22,436.09
| Facility | | $1,350.00 | $17,765.12 | $22,436.09 |