- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,818.54 / $13,548.00 / $22,674.60
| Facility | | $9,818.54 | $13,548.00 | $22,674.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,790.53 / $11,790.53 / $11,790.53
| Facility | | $11,790.53 | $11,790.53 | $11,790.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $15,534.97 / $23,993.88
| Facility | | $2,423.00 | $15,534.97 | $23,993.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,049.20 / $15,242.13 / $25,560.96
| Facility | | $10,049.20 | $15,242.13 | $25,560.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $12,301.24 / $27,353.23
| Facility | | $2,600.00 | $12,301.24 | $27,353.23 |