- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,196.90 / $19,586.80 / $39,805.50
| Facility | | $15,196.90 | $19,586.80 | $39,805.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,442.50 / $19,357.50 / $22,130.63
| Facility | | $15,442.50 | $19,357.50 | $22,130.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,130.40 / $21,472.09 / $27,925.38
| Facility | | $12,130.40 | $21,472.09 | $27,925.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,623.61 / $27,623.61 / $27,623.61
| Facility | | $27,623.61 | $27,623.61 | $27,623.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $17,220.08 / $26,519.35
| Facility | | $1,286.00 | $17,220.08 | $26,519.35 |