- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,569.80 / $17,344.30 / $29,028.20
| Facility | | $12,569.80 | $17,344.30 | $29,028.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,736.22 / $20,736.22 / $20,736.22
| Facility | | $20,736.22 | $20,736.22 | $20,736.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $19,887.62 / $30,630.16
| Facility | | $3,272.00 | $19,887.62 | $30,630.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,865.05 / $19,513.06 / $32,723.28
| Facility | | $12,865.05 | $19,513.06 | $32,723.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $19,898.13 / $35,017.76
| Facility | | $4,062.00 | $19,898.13 | $35,017.76 |