- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,596.00 / $15,452.50 / $25,084.30
| Facility | | $10,596.00 | $15,452.50 | $25,084.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,161.22 / $20,161.22 / $20,161.22
| Facility | | $20,161.22 | $20,161.22 | $20,161.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,257.48 / $30,220.68 / $38,744.46
| Facility | | $21,257.48 | $30,220.68 | $38,744.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,442.19 / $24,055.82 / $30,426.26
| Facility | | $12,442.19 | $24,055.82 | $30,426.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,055.20 / $16,618.09 / $26,573.00
| Facility | | $11,055.20 | $16,618.09 | $26,573.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,928.89 / $21,112.53 / $33,202.57
| Facility | | $12,928.89 | $21,112.53 | $33,202.57 |