- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,743.15 / $17,888.50 / $24,005.00
| Facility | | $9,743.15 | $17,888.50 | $24,005.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,771.65 / $14,771.65 / $14,771.65
| Facility | | $14,771.65 | $14,771.65 | $14,771.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,185.00 / $14,328.60 / $23,812.58
| Facility | | $2,185.00 | $14,328.60 | $23,812.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,966.44 / $10,966.44 / $14,996.40
| Facility | | $10,966.44 | $10,966.44 | $14,996.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,495.71 / $14,187.92 / $20,098.91
| Facility | | $10,495.71 | $14,187.92 | $20,098.91 |