- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,808.30 / $19,053.30 / $31,888.50
| Facility | | $13,808.30 | $19,053.30 | $31,888.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,318.20 / $21,318.20 / $21,318.20
| Facility | | $21,318.20 | $21,318.20 | $21,318.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $22,468.97 / $34,605.86
| Facility | | $3,272.00 | $22,468.97 | $34,605.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,132.73 / $21,435.80 / $35,947.71
| Facility | | $14,132.73 | $21,435.80 | $35,947.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $21,858.82 / $38,468.28
| Facility | | $4,062.00 | $21,858.82 | $38,468.28 |