- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,082.40 / $15,861.40 / $18,287.20
| Facility | | $13,082.40 | $15,861.40 | $18,287.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,842.97 / $17,147.68 / $23,458.42
| Facility | | $14,842.97 | $17,147.68 | $23,458.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,715.00 / $14,552.00
| Facility | | $1,252.00 | $3,715.00 | $14,552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,637.70 / $18,524.00 / $31,792.99
| Facility | | $11,637.70 | $18,524.00 | $31,792.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $18,026.40 / $27,992.68
| Facility | | $3,137.00 | $18,026.40 | $27,992.68 |