- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,973.80 / $20,092.40 / $22,727.30
| Facility | | $12,973.80 | $20,092.40 | $22,727.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,092.00 / $20,959.62 / $29,058.56
| Facility | | $3,092.00 | $20,959.62 | $29,058.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,844.00 / $16,502.37 / $23,505.00
| Facility | | $5,844.00 | $16,502.37 | $23,505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,231.00 / $22,989.00 / $27,878.00
| Facility | | $16,231.00 | $22,989.00 | $27,878.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $23,384.54 / $30,891.52
| Facility | | $5,274.00 | $23,384.54 | $30,891.52 |