- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,599.20 / $17,893.20 / $31,486.80
| Facility | | $10,599.20 | $17,893.20 | $31,486.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,275.36 / $17,392.93 / $40,123.12
| Facility | | $15,275.36 | $17,392.93 | $40,123.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,446.25 / $9,460.26 / $15,604.53
| Facility | | $6,446.25 | $9,460.26 | $15,604.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,641.62 / $16,493.14 / $22,774.06
| Facility | | $9,641.62 | $16,493.14 | $22,774.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,039.25 / $34,039.25 / $39,947.94
| Facility | | $34,039.25 | $34,039.25 | $39,947.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $15,593.75 / $22,273.88
| Facility | | $1,787.00 | $15,593.75 | $22,273.88 |