- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,114.18 / $10,611.30 / $14,234.10
| Facility | | $5,114.18 | $10,611.30 | $14,234.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,686.24 / $23,686.24 / $23,686.24
| Facility | | $23,686.24 | $23,686.24 | $23,686.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $14,162.29 / $16,839.62
| Facility | | $2,651.00 | $14,162.29 | $16,839.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,019.59 / $10,957.30 / $17,246.46
| Facility | | $9,019.59 | $10,957.30 | $17,246.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $13,537.46
| Facility | | $1,350.00 | $5,713.00 | $13,537.46 |