- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,957.70 / $16,511.20 / $22,148.40
| Facility | | $7,957.70 | $16,511.20 | $22,148.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,067.03 / $22,067.03 / $22,067.03
| Facility | | $22,067.03 | $22,067.03 | $22,067.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $14,595.67 / $17,354.93
| Facility | | $2,651.00 | $14,595.67 | $17,354.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,034.55 / $17,049.65 / $26,835.63
| Facility | | $14,034.55 | $17,049.65 | $26,835.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $21,064.39
| Facility | | $1,350.00 | $5,713.00 | $21,064.39 |