- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,937.30 / $21,041.50 / $21,041.50
| Facility | | $18,937.30 | $21,041.50 | $21,041.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,546.00 / $24,546.00 / $24,546.00
| Facility | | $24,546.00 | $24,546.00 | $24,546.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,270.92 / $14,597.34 / $25,705.32
| Facility | | $7,270.92 | $14,597.34 | $25,705.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,805.00 / $23,167.38 / $36,409.15
| Facility | | $14,805.00 | $23,167.38 | $36,409.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $31,435.49 / $40,588.48
| Facility | | $6,965.00 | $31,435.49 | $40,588.48 |