- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,557.70 / $16,437.70 / $18,951.70
| Facility | | $13,557.70 | $16,437.70 | $18,951.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,327.82 / $32,327.82 / $32,327.82
| Facility | | $32,327.82 | $32,327.82 | $32,327.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,702.00 / $6,578.00
| Facility | | $1,252.00 | $3,702.00 | $6,578.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,060.52 / $19,197.02 / $32,948.08
| Facility | | $12,060.52 | $19,197.02 | $32,948.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $18,681.33 / $29,009.71
| Facility | | $3,137.00 | $18,681.33 | $29,009.71 |