- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,724.38 / $13,040.00 / $22,946.70
| Facility | | $7,724.38 | $13,040.00 | $22,946.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.00 / $2,920.00 / $2,920.00
| Facility | | $2,920.00 | $2,920.00 | $2,920.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,544.81 / $15,569.63 / $25,525.97
| Facility | | $10,544.81 | $15,569.63 | $25,525.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,026.53 / $12,019.72 / $16,870.11
| Facility | | $7,026.53 | $12,019.72 | $16,870.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,399.50 / $23,399.50 / $27,461.30
| Facility | | $23,399.50 | $23,399.50 | $27,461.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $11,364.27 / $16,232.56
| Facility | | $1,787.00 | $11,364.27 | $16,232.56 |