- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,490.40 / $18,676.09 / $37,954.80
| Facility | | $14,490.40 | $18,676.09 | $37,954.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,855.02 / $19,855.02 / $19,855.02
| Facility | | $19,855.02 | $19,855.02 | $19,855.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,252.86 / $16,612.74 / $18,992.66
| Facility | | $13,252.86 | $16,612.74 | $18,992.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,465.31 / $19,050.20 / $26,186.20
| Facility | | $11,465.31 | $19,050.20 | $26,186.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,833.27 / $22,833.27 / $22,833.27
| Facility | | $22,833.27 | $22,833.27 | $22,833.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $21,021.75 / $28,796.73
| Facility | | $2,000.00 | $21,021.75 | $28,796.73 |