- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,952.50 / $16,690.50 / $33,926.80
| Facility | | $12,952.50 | $16,690.50 | $33,926.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,492.12 / $22,492.12 / $23,351.11
| Facility | | $22,492.12 | $22,492.12 | $23,351.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,989.45 / $16,282.55 / $18,615.16
| Facility | | $12,989.45 | $16,282.55 | $18,615.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,248.53 / $17,028.46 / $23,407.13
| Facility | | $10,248.53 | $17,028.46 | $23,407.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,865.94 / $25,865.94 / $26,853.78
| Facility | | $25,865.94 | $25,865.94 | $26,853.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $15,878.89 / $23,378.21
| Facility | | $1,518.00 | $15,878.89 | $23,378.21 |