- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,099.40 / $23,975.10 / $41,947.40
| Facility | | $18,099.40 | $23,975.10 | $41,947.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,976.25 / $10,976.25 / $10,976.25
| Facility | | $10,976.25 | $10,976.25 | $10,976.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $21,412.93 / $43,775.28
| Facility | | $5,939.30 | $21,412.93 | $43,775.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,649.06 / $23,002.15 / $37,451.69
| Facility | | $13,649.06 | $23,002.15 | $37,451.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $24,707.53 / $37,737.69
| Facility | | $3,496.00 | $24,707.53 | $37,737.69 |