- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,737.77 / $16,054.90 / $21,536.30
| Facility | | $7,737.77 | $16,054.90 | $21,536.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,915.46 / $16,917.62 / $20,701.30
| Facility | | $16,915.46 | $16,917.62 | $20,701.30 |
- 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
- $13,646.68 / $20,131.47 / $22,599.05
| Facility | | $13,646.68 | $20,131.47 | $22,599.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $20,482.24
| Facility | | $1,350.00 | $5,713.00 | $20,482.24 |