- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,492.57 / $15,546.20 / $20,853.80
| Facility | | $7,492.57 | $15,546.20 | $20,853.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,200.24 / $13,200.24 / $13,200.24
| Facility | | $13,200.24 | $13,200.24 | $13,200.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $17,321.34 / $20,595.89
| Facility | | $3,897.00 | $17,321.34 | $20,595.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,214.24 / $16,053.10 / $25,267.09
| Facility | | $13,214.24 | $16,053.10 | $25,267.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $18,342.78 / $25,047.91
| Facility | | $1,500.00 | $18,342.78 | $25,047.91 |