- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,193.41 / $12,850.60 / $17,237.90
| Facility | | $6,193.41 | $12,850.60 | $17,237.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,349.25 / $6,796.00 / $24,797.64
| Facility | | $4,349.25 | $6,796.00 | $24,797.64 |
- 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
- $10,922.98 / $16,113.48 / $18,088.56
| Facility | | $10,922.98 | $16,113.48 | $18,088.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $16,394.24
| Facility | | $1,350.00 | $5,713.00 | $16,394.24 |