- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,783.90 / $22,921.00 / $46,581.50
| Facility | | $17,783.90 | $22,921.00 | $46,581.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,701.72 / $22,189.48 / $25,368.31
| Facility | | $17,701.72 | $22,189.48 | $25,368.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,195.32 / $25,127.21 / $32,679.03
| Facility | | $14,195.32 | $25,127.21 | $32,679.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,215.10 / $27,215.10 / $27,215.10
| Facility | | $27,215.10 | $27,215.10 | $27,215.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.00 / $25,799.75 / $35,341.89
| Facility | | $1,857.00 | $25,799.75 | $35,341.89 |