- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,070.40 / $15,275.30 / $25,565.50
| Facility | | $11,070.40 | $15,275.30 | $25,565.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,112.22 / $26,112.22 / $26,112.22
| Facility | | $26,112.22 | $26,112.22 | $26,112.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $17,886.36 / $27,043.23
| Facility | | $2,423.00 | $17,886.36 | $27,043.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,330.43 / $17,185.41 / $28,819.84
| Facility | | $11,330.43 | $17,185.41 | $28,819.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $13,869.58 / $30,840.62
| Facility | | $2,600.00 | $13,869.58 | $30,840.62 |