- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.65 / $16,584.00 / $29,183.00
| Facility | | $9,823.65 | $16,584.00 | $29,183.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,554.13 / $4,554.13 / $4,554.13
| Facility | | $4,554.13 | $4,554.13 | $4,554.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,755.68 / $14,434.92 / $23,810.15
| Facility | | $9,755.68 | $14,434.92 | $23,810.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,936.15 / $15,286.35 / $21,107.71
| Facility | | $8,936.15 | $15,286.35 | $21,107.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,162.30 / $30,162.30 / $35,398.01
| Facility | | $30,162.30 | $30,162.30 | $35,398.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.00 / $15,240.36 / $20,533.63
| Facility | | $2,520.00 | $15,240.36 | $20,533.63 |