- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,551.00 / $22,620.80 / $45,971.50
| Facility | | $17,551.00 | $22,620.80 | $45,971.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,554.75 / $22,005.25 / $25,157.69
| Facility | | $17,554.75 | $22,005.25 | $25,157.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,886.96 / $22,966.15 / $31,717.14
| Facility | | $13,886.96 | $22,966.15 | $31,717.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,103.87 / $13,543.67 / $30,427.49
| Facility | | $5,103.87 | $13,543.67 | $30,427.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.00 / $2,000.00 / $28,214.78
| Facility | | $372.00 | $2,000.00 | $28,214.78 |