- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,839.14 / $22,473.40 / $39,404.40
| Facility | | $15,839.14 | $22,473.40 | $39,404.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,092.48 / $27,092.48 / $27,092.48
| Facility | | $27,092.48 | $27,092.48 | $27,092.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.59 / $1,924.00 / $20,869.18
| Facility | | $1,055.59 | $1,924.00 | $20,869.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,473.40 / $22,473.40 / $22,473.40
| Facility | | $22,473.40 | $22,473.40 | $22,473.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,233.04 / $22,237.81 / $29,799.33
| Facility | | $14,233.04 | $22,237.81 | $29,799.33 |