- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,055.96 / $12,565.40 / $16,855.30
| Facility | | $6,055.96 | $12,565.40 | $16,855.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,770.20 / $12,770.20 / $15,716.86
| Facility | | $12,770.20 | $12,770.20 | $15,716.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $13,221.02 / $15,720.41
| Facility | | $3,897.00 | $13,221.02 | $15,720.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,680.56 / $12,975.10 / $20,422.41
| Facility | | $10,680.56 | $12,975.10 | $20,422.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $16,030.39 / $20,245.25
| Facility | | $1,350.00 | $16,030.39 | $20,245.25 |