- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,282.90 / $13,621.10 / $23,831.70
| Facility | | $10,282.90 | $13,621.10 | $23,831.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,974.41 / $24,974.41 / $24,974.41
| Facility | | $24,974.41 | $24,974.41 | $24,974.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $13,148.08 / $25,966.68
| Facility | | $5,843.91 | $13,148.08 | $25,966.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,863.34 / $13,955.51 / $21,279.29
| Facility | | $9,863.34 | $13,955.51 | $21,279.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $6,310.34 / $16,285.76
| Facility | | $3,500.00 | $6,310.34 | $16,285.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,037.18 / $24,835.20
| Facility | | $3,496.00 | $14,037.18 | $24,835.20 |