- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $20,892.96 / $27,542.29
| Facility | | $13,803.84 | $20,892.96 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $20,892.96 / $27,542.29
| Facility | | $10,000.00 | $20,892.96 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $16,595.87 / $24,547.09
| Facility | | $10,232.93 | $16,595.87 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $15,135.61 / $23,442.29
| Facility | | $6,165.95 | $15,135.61 | $23,442.29 |