- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,387.50 / $25,500.50 / $30,791.30
| Facility | | $13,387.50 | $25,500.50 | $30,791.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $23,026.50 / $39,525.26
| Facility | | $6,916.00 | $23,026.50 | $39,525.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,041.06 / $21,540.30 / $26,048.26
| Facility | | $19,041.06 | $21,540.30 | $26,048.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,245.61 / $19,041.70 / $24,642.20
| Facility | | $13,245.61 | $19,041.70 | $24,642.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,965.92 / $24,093.51 / $36,731.87
| Facility | | $13,965.92 | $24,093.51 | $36,731.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,460.93 / $21,295.27 / $28,078.35
| Facility | | $15,460.93 | $21,295.27 | $28,078.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $20,995.88 / $30,245.04
| Facility | | $3,775.00 | $20,995.88 | $30,245.04 |