- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,287.72 / $15,121.10 / $20,283.70
| Facility | | $7,287.72 | $15,121.10 | $20,283.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,880.53 / $15,880.53 / $15,880.53
| Facility | | $15,880.53 | $15,880.53 | $15,880.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $14,924.23 / $17,745.59
| Facility | | $3,897.00 | $14,924.23 | $17,745.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,852.95 / $15,614.20 / $24,576.27
| Facility | | $12,852.95 | $15,614.20 | $24,576.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $19,290.93 / $24,363.08
| Facility | | $1,350.00 | $19,290.93 | $24,363.08 |