- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,488.20 / $14,472.10 / $24,221.20
| Facility | | $10,488.20 | $14,472.10 | $24,221.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,603.59 / $19,603.59 / $19,603.59
| Facility | | $19,603.59 | $19,603.59 | $19,603.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $17,143.58 / $26,403.90
| Facility | | $2,423.00 | $17,143.58 | $26,403.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,734.63 / $16,281.74 / $27,304.38
| Facility | | $10,734.63 | $16,281.74 | $27,304.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $13,140.27 / $29,218.90
| Facility | | $2,600.00 | $13,140.27 | $29,218.90 |