- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,154.70 / $20,432.70 / $28,930.50
| Facility | | $11,154.70 | $20,432.70 | $28,930.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,148.36 / $20,148.36 / $20,148.36
| Facility | | $20,148.36 | $20,148.36 | $20,148.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,654.15 / $22,136.07 / $35,036.69
| Facility | | $13,654.15 | $22,136.07 | $35,036.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,597.52 / $21,785.00 / $32,701.49
| Facility | | $11,597.52 | $21,785.00 | $32,701.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $17,451.84 / $38,669.58
| Facility | | $7,117.00 | $17,451.84 | $38,669.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $16,964.00 / $34,363.80
| Facility | | $3,308.00 | $16,964.00 | $34,363.80 |