- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,321.60 / $21,111.80 / $35,050.60
| Facility | | $13,321.60 | $21,111.80 | $35,050.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,825.14 / $20,710.88 / $35,084.67
| Facility | | $13,825.14 | $20,710.88 | $35,084.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.74 / $23,522.76 / $43,442.00
| Facility | | $18,197.74 | $23,522.76 | $43,442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,879.91 / $22,606.90 / $61,820.58
| Facility | | $10,879.91 | $22,606.90 | $61,820.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,879.91 / $21,584.25 / $30,335.60
| Facility | | $10,879.91 | $21,584.25 | $30,335.60 |