- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,149.60 / $14,801.50 / $24,027.50
| Facility | | $10,149.60 | $14,801.50 | $24,027.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,605.14 / $19,605.14 / $19,605.14
| Facility | | $19,605.14 | $19,605.14 | $19,605.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,905.34 / $31,141.71 / $39,925.26
| Facility | | $21,905.34 | $31,141.71 | $39,925.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,918.02 / $23,042.37 / $29,144.42
| Facility | | $11,918.02 | $23,042.37 | $29,144.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,589.40 / $15,918.00 / $25,453.50
| Facility | | $10,589.40 | $15,918.00 | $25,453.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,384.20 / $21,177.14 / $32,174.23
| Facility | | $12,384.20 | $21,177.14 | $32,174.23 |