- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,751.20 / $21,762.00 / $35,268.80
| Facility | | $8,751.20 | $21,762.00 | $35,268.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.00 / $13,736.27 / $17,677.30
| Facility | | $2,920.00 | $13,736.27 | $17,677.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,714.61 / $12,758.56 / $21,156.86
| Facility | | $8,714.61 | $12,758.56 | $21,156.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,871.11 / $13,464.48 / $18,735.56
| Facility | | $7,871.11 | $13,464.48 | $18,735.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,204.90 / $27,204.90 / $31,927.26
| Facility | | $27,204.90 | $27,204.90 | $31,927.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.00 / $13,514.04 / $18,183.68
| Facility | | $2,520.00 | $13,514.04 | $18,183.68 |