- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,559.40 / $14,570.30 / $24,385.60
| Facility | | $10,559.40 | $14,570.30 | $24,385.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,943.68 / $26,943.68 / $26,943.68
| Facility | | $26,943.68 | $26,943.68 | $26,943.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $16,824.12 / $25,911.87
| Facility | | $2,423.00 | $16,824.12 | $25,911.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,807.49 / $16,392.25 / $27,489.72
| Facility | | $10,807.49 | $16,392.25 | $27,489.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $13,229.46 / $29,512.77
| Facility | | $2,600.00 | $13,229.46 | $29,512.77 |