- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,247.20 / $24,697.40 / $41,003.40
| Facility | | $19,247.20 | $24,697.40 | $41,003.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,868.04 / $24,868.04 / $24,868.04
| Facility | | $24,868.04 | $24,868.04 | $24,868.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,955.46 / $23,902.22 / $40,490.86
| Facility | | $15,955.46 | $23,902.22 | $40,490.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,288.34 / $26,342.57 / $37,877.41
| Facility | | $21,288.34 | $26,342.57 | $37,877.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,727.69 / $26,446.33 / $71,346.50
| Facility | | $12,727.69 | $26,446.33 | $71,346.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,727.69 / $25,250.00 / $35,487.62
| Facility | | $12,727.69 | $25,250.00 | $35,487.62 |