- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,424.70 / $22,663.10 / $39,880.50
| Facility | | $13,424.70 | $22,663.10 | $39,880.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,469.94 / $12,062.09 / $19,954.00
| Facility | | $8,469.94 | $12,062.09 | $19,954.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,211.85 / $20,600.34 / $28,813.33
| Facility | | $12,211.85 | $20,600.34 | $28,813.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,795.60 / $44,795.60 / $52,571.44
| Facility | | $44,795.60 | $44,795.60 | $52,571.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $19,750.68 / $28,211.60
| Facility | | $1,787.00 | $19,750.68 | $28,211.60 |