- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,491.86 / $19,694.40 / $26,418.40
| Facility | | $9,491.86 | $19,694.40 | $26,418.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,326.59 / $21,326.59 / $21,326.59
| Facility | | $21,326.59 | $21,326.59 | $21,326.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $24,945.08 / $29,660.86
| Facility | | $3,897.00 | $24,945.08 | $29,660.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,740.27 / $20,336.65 / $32,009.27
| Facility | | $16,740.27 | $20,336.65 | $32,009.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $25,125.40 / $31,731.60
| Facility | | $1,350.00 | $25,125.40 | $31,731.60 |