- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,090.00 / $25,809.50 / $36,543.50
| Facility | | $14,090.00 | $25,809.50 | $36,543.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,531.18 / $23,293.49 / $36,603.48
| Facility | | $14,531.18 | $23,293.49 | $36,603.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,649.36 / $23,217.02 / $41,306.76
| Facility | | $14,649.36 | $23,217.02 | $41,306.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $21,905.23 / $48,845.32
| Facility | | $7,117.00 | $21,905.23 | $48,845.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $21,428.02 / $43,406.50
| Facility | | $3,308.00 | $21,428.02 | $43,406.50 |