- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,681.90 / $24,746.70 / $43,297.40
| Facility | | $18,681.90 | $24,746.70 | $43,297.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,341.11 / $21,341.11 / $21,341.11
| Facility | | $21,341.11 | $21,341.11 | $21,341.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $21,125.00 / $44,539.16
| Facility | | $5,939.30 | $21,125.00 | $44,539.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,088.34 / $23,742.44 / $38,657.03
| Facility | | $14,088.34 | $23,742.44 | $38,657.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,173.85 / $12,665.85 / $27,217.78
| Facility | | $5,173.85 | $12,665.85 | $27,217.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $25,502.70 / $38,952.22
| Facility | | $3,496.00 | $25,502.70 | $38,952.22 |