- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,814.60 / $30,905.10 / $30,905.10
| Facility | | $27,814.60 | $30,905.10 | $30,905.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,892.31 / $5,892.31 / $5,892.31
| Facility | | $5,892.31 | $5,892.31 | $5,892.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,423.00 / $16,986.15 / $44,919.10
| Facility | | $10,423.00 | $16,986.15 | $44,919.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,287.78 / $34,027.56 / $53,476.70
| Facility | | $19,287.78 | $34,027.56 | $53,476.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $46,171.52 / $59,615.17
| Facility | | $6,965.00 | $46,171.52 | $59,615.17 |