- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,445.60 / $22,698.40 / $39,942.60
| Facility | | $13,445.60 | $22,698.40 | $39,942.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,512.00 / $10,512.00 / $10,512.00
| Facility | | $10,512.00 | $10,512.00 | $10,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,007.12 / $8,888.40 / $14,661.26
| Facility | | $6,007.12 | $8,888.40 | $14,661.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,872.05 / $23,514.68 / $30,277.89
| Facility | | $13,872.05 | $23,514.68 | $30,277.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,260.30 / $44,260.30 / $51,943.22
| Facility | | $44,260.30 | $44,260.30 | $51,943.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $19,781.43 / $28,255.50
| Facility | | $1,787.00 | $19,781.43 | $28,255.50 |