- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,491.24 / $15,543.40 / $20,850.09
| Facility | | $7,491.24 | $15,543.40 | $20,850.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,663.62 / $27,663.62 / $27,663.62
| Facility | | $27,663.62 | $27,663.62 | $27,663.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $15,346.82 / $18,248.09
| Facility | | $3,897.00 | $15,346.82 | $18,248.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,211.89 / $16,050.25 / $25,262.60
| Facility | | $13,211.89 | $16,050.25 | $25,262.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $19,829.66 / $25,043.46
| Facility | | $1,350.00 | $19,829.66 | $25,043.46 |