- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,418.00 / $16,005.10 / $32,526.50
| Facility | | $12,418.00 | $16,005.10 | $32,526.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,843.74 / $19,843.74 / $19,843.74
| Facility | | $19,843.74 | $19,843.74 | $19,843.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,286.55 / $15,401.45 / $17,607.84
| Facility | | $12,286.55 | $15,401.45 | $17,607.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,912.19 / $17,545.61 / $22,818.83
| Facility | | $9,912.19 | $17,545.61 | $22,818.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,820.30 / $22,820.30 / $22,820.30
| Facility | | $22,820.30 | $22,820.30 | $22,820.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $15,942.68 / $22,413.33
| Facility | | $1,518.00 | $15,942.68 | $22,413.33 |