- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,051.20 / $12,489.20 / $20,902.50
| Facility | | $9,051.20 | $12,489.20 | $20,902.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,755.78 / $20,755.78 / $20,755.78
| Facility | | $20,755.78 | $20,755.78 | $20,755.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $14,627.08 / $22,115.37
| Facility | | $2,423.00 | $14,627.08 | $22,115.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,263.84 / $14,050.93 / $23,563.32
| Facility | | $9,263.84 | $14,050.93 | $23,563.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,160.00 / $9,658.93 / $24,711.24
| Facility | | $2,160.00 | $9,658.93 | $24,711.24 |