- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,786.20 / $28,604.60 / $38,370.60
| Facility | | $13,786.20 | $28,604.60 | $38,370.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,813.44 / $48,813.44 / $48,813.44
| Facility | | $48,813.44 | $48,813.44 | $48,813.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $32,637.97 / $38,808.06
| Facility | | $3,897.00 | $32,637.97 | $38,808.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,313.94 / $29,537.40 / $46,490.97
| Facility | | $24,313.94 | $29,537.40 | $46,490.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $36,511.33 / $52,358.93
| Facility | | $1,350.00 | $36,511.33 | $52,358.93 |