- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,571.20 / $15,966.40 / $26,722.10
| Facility | | $11,571.20 | $15,966.40 | $26,722.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,613.65 / $19,613.65 / $19,613.65
| Facility | | $19,613.65 | $19,613.65 | $19,613.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $17,652.04 / $27,706.86
| Facility | | $2,423.00 | $17,652.04 | $27,706.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,843.04 / $17,962.93 / $30,123.72
| Facility | | $11,843.04 | $17,962.93 | $30,123.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $14,497.07 / $32,235.92
| Facility | | $2,600.00 | $14,497.07 | $32,235.92 |