- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,354.70 / $14,287.80 / $23,912.70
| Facility | | $10,354.70 | $14,287.80 | $23,912.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,791.79 / $15,791.79 / $15,791.79
| Facility | | $15,791.79 | $15,791.79 | $15,791.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $16,919.75 / $26,059.18
| Facility | | $3,272.00 | $16,919.75 | $26,059.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,597.93 / $16,074.41 / $26,956.68
| Facility | | $10,597.93 | $16,074.41 | $26,956.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $16,391.62 / $28,846.82
| Facility | | $4,062.00 | $16,391.62 | $28,846.82 |