- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,391.92 / $15,337.30 / $20,573.70
| Facility | | $7,391.92 | $15,337.30 | $20,573.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,203.74 / $17,203.74 / $17,203.74
| Facility | | $17,203.74 | $17,203.74 | $17,203.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $17,318.63 / $20,592.65
| Facility | | $2,651.00 | $17,318.63 | $20,592.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,036.72 / $15,837.45 / $24,927.66
| Facility | | $13,036.72 | $15,837.45 | $24,927.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $19,566.75
| Facility | | $1,350.00 | $5,713.00 | $19,566.75 |