- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,839.96 / $13,577.60 / $22,724.10
| Facility | | $9,839.96 | $13,577.60 | $22,724.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,521.85 / $26,521.85 / $26,521.85
| Facility | | $26,521.85 | $26,521.85 | $26,521.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $16,046.43 / $24,879.22
| Facility | | $2,423.00 | $16,046.43 | $24,879.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,071.12 / $15,275.38 / $25,616.72
| Facility | | $10,071.12 | $15,275.38 | $25,616.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $12,328.08 / $27,412.91
| Facility | | $2,600.00 | $12,328.08 | $27,412.91 |