- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,341.50 / $18,409.20 / $30,810.40
| Facility | | $13,341.50 | $18,409.20 | $30,810.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,719.57 / $19,719.57 / $19,719.57
| Facility | | $19,719.57 | $19,719.57 | $19,719.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $20,786.84 / $32,015.13
| Facility | | $3,272.00 | $20,786.84 | $32,015.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,654.93 / $20,711.11 / $34,732.40
| Facility | | $13,654.93 | $20,711.11 | $34,732.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,350.00 / $21,134.65 / $37,167.75
| Facility | | $4,350.00 | $21,134.65 | $37,167.75 |