- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,133.86 / $14,801.90 / $19,855.40
| Facility | | $7,133.86 | $14,801.90 | $19,855.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,626.55 / $19,626.55 / $19,626.55
| Facility | | $19,626.55 | $19,626.55 | $19,626.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.00 / $850.00 / $850.00
| Facility | | $850.00 | $850.00 | $850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,581.60 / $18,560.27 / $20,835.25
| Facility | | $12,581.60 | $18,560.27 | $20,835.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $18,883.66
| Facility | | $1,350.00 | $5,713.00 | $18,883.66 |