- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,119.20 / $23,835.50 / $41,943.50
| Facility | | $14,119.20 | $23,835.50 | $41,943.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,760.00 / $8,760.00 / $8,760.00
| Facility | | $8,760.00 | $8,760.00 | $8,760.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,600.44 / $19,911.62 / $32,699.06
| Facility | | $13,600.44 | $19,911.62 | $32,699.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,843.58 / $21,606.22 / $30,051.10
| Facility | | $12,843.58 | $21,606.22 | $30,051.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,368.95 / $44,368.95 / $52,070.73
| Facility | | $44,368.95 | $44,368.95 | $52,070.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $20,772.40 / $29,671.00
| Facility | | $1,787.00 | $20,772.40 | $29,671.00 |