- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,880.68 / $14,276.60 / $19,150.80
| Facility | | $6,880.68 | $14,276.60 | $19,150.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,951.71 / $15,951.71 / $15,951.71
| Facility | | $15,951.71 | $15,951.71 | $15,951.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $13,350.03 / $15,873.81
| Facility | | $3,897.00 | $13,350.03 | $15,873.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,135.08 / $14,742.10 / $23,203.62
| Facility | | $12,135.08 | $14,742.10 | $23,203.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $16,844.79 / $21,476.91
| Facility | | $1,500.00 | $16,844.79 | $21,476.91 |