- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,833.20 / $18,288.20 / $32,181.90
| Facility | | $10,833.20 | $18,288.20 | $32,181.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,975.10 / $31,035.67 / $50,844.96
| Facility | | $20,975.10 | $31,035.67 | $50,844.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,854.46 / $16,857.25 / $23,276.84
| Facility | | $9,854.46 | $16,857.25 | $23,276.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,609.00 / $34,609.00 / $40,616.60
| Facility | | $34,609.00 | $34,609.00 | $40,616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $15,938.01 / $22,765.62
| Facility | | $1,787.00 | $15,938.01 | $22,765.62 |