- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,054.61 / $26,915.35
| Facility | | $12,882.50 | $19,054.61 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $12,882.50
| Facility | | $12,882.50 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $16,982.44 / $28,840.32
| Facility | | $6,309.57 | $16,982.44 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,488.17 / $26,302.68
| Facility | | $11,481.54 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $17,378.01 / $25,703.96
| Facility | | $14,125.38 | $17,378.01 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $16,982.44 / $24,547.09
| Facility | | $8,912.51 | $16,982.44 | $24,547.09 |