- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,623.20 / $21,290.90 / $30,145.60
| Facility | | $11,623.20 | $21,290.90 | $30,145.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,837.55 / $20,837.55 / $20,837.55
| Facility | | $20,837.55 | $20,837.55 | $20,837.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,197.50 / $17,859.30 / $28,042.26
| Facility | | $11,197.50 | $17,859.30 | $28,042.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,084.60 / $19,152.25 / $34,074.91
| Facility | | $12,084.60 | $19,152.25 | $34,074.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $18,255.25 / $40,293.65
| Facility | | $7,117.00 | $18,255.25 | $40,293.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $17,676.47 / $35,807.04
| Facility | | $3,308.00 | $17,676.47 | $35,807.04 |