- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,922.10 / $17,943.70 / $36,466.40
| Facility | | $13,922.10 | $17,943.70 | $36,466.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,706.75 / $20,706.75 / $20,706.75
| Facility | | $20,706.75 | $20,706.75 | $20,706.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,838.22 / $16,092.98 / $18,398.43
| Facility | | $12,838.22 | $16,092.98 | $18,398.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,112.82 / $19,670.84 / $25,582.79
| Facility | | $11,112.82 | $19,670.84 | $25,582.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,812.76 / $23,812.76 / $23,812.76
| Facility | | $23,812.76 | $23,812.76 | $23,812.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $17,873.75 / $25,128.18
| Facility | | $1,518.00 | $17,873.75 | $25,128.18 |