- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,376.20 / $13,673.60 / $22,196.60
| Facility | | $9,376.20 | $13,673.60 | $22,196.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,346.50 / $22,346.50 / $22,346.50
| Facility | | $22,346.50 | $22,346.50 | $22,346.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,163.93 / $22,979.45 / $29,460.83
| Facility | | $16,163.93 | $22,979.45 | $29,460.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,009.86 / $21,286.54 / $26,923.62
| Facility | | $11,009.86 | $21,286.54 | $26,923.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,782.50 / $14,705.00 / $23,513.90
| Facility | | $9,782.50 | $14,705.00 | $23,513.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,440.53 / $19,563.43 / $29,722.55
| Facility | | $11,440.53 | $19,563.43 | $29,722.55 |