- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,021.70 / $16,918.30 / $29,771.30
| Facility | | $10,021.70 | $16,918.30 | $29,771.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.00 / $2,920.00 / $2,920.00
| Facility | | $2,920.00 | $2,920.00 | $2,920.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,279.98 / $12,225.56 / $20,101.68
| Facility | | $8,279.98 | $12,225.56 | $20,101.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,116.32 / $15,594.55 / $21,533.28
| Facility | | $9,116.32 | $15,594.55 | $21,533.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,620.75 / $30,620.75 / $35,936.05
| Facility | | $30,620.75 | $30,620.75 | $35,936.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $14,744.16 / $21,060.35
| Facility | | $1,787.00 | $14,744.16 | $21,060.35 |