- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,326.80 / $13,696.50 / $13,696.50
| Facility | | $12,326.80 | $13,696.50 | $13,696.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,546.00 / $24,546.00 / $24,546.00
| Facility | | $24,546.00 | $24,546.00 | $24,546.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,365.93 / $5,450.50 / $12,249.14
| Facility | | $3,365.93 | $5,450.50 | $12,249.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,321.81 / $15,454.00 / $23,699.73
| Facility | | $11,321.81 | $15,454.00 | $23,699.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $20,462.23 / $26,420.17
| Facility | | $6,965.00 | $20,462.23 | $26,420.17 |