- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,566.40 / $20,892.30 / $27,345.10
| Facility | | $12,566.40 | $20,892.30 | $27,345.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,511.16 / $20,511.16 / $20,511.16
| Facility | | $20,511.16 | $20,511.16 | $20,511.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,322.02 / $18,141.93 / $27,485.42
| Facility | | $11,322.02 | $18,141.93 | $27,485.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $16,533.25 / $28,304.03
| Facility | | $7,516.00 | $16,533.25 | $28,304.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $16,093.57 / $25,125.80
| Facility | | $7,516.00 | $16,093.57 | $25,125.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,796.88 / $21,324.56 / $31,053.76
| Facility | | $7,796.88 | $21,324.56 | $31,053.76 |