- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,980.45 / $14,483.60 / $19,428.40
| Facility | | $6,980.45 | $14,483.60 | $19,428.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,077.34 / $14,077.34 / $14,077.34
| Facility | | $14,077.34 | $14,077.34 | $14,077.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $15,299.80 / $18,192.18
| Facility | | $3,897.00 | $15,299.80 | $18,192.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,311.03 / $14,955.85 / $23,540.05
| Facility | | $12,311.03 | $14,955.85 | $23,540.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $18,477.56 / $23,335.85
| Facility | | $1,350.00 | $18,477.56 | $23,335.85 |