- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,789.83 / $20,312.70 / $27,247.70
| Facility | | $9,789.83 | $20,312.70 | $27,247.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,699.55 / $20,699.55 / $20,699.55
| Facility | | $20,699.55 | $20,699.55 | $20,699.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $24,359.17 / $28,964.18
| Facility | | $2,651.00 | $24,359.17 | $28,964.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,265.78 / $20,975.05 / $33,014.08
| Facility | | $17,265.78 | $20,975.05 | $33,014.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $25,914.12
| Facility | | $1,350.00 | $5,713.00 | $25,914.12 |