- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,096.80 / $26,004.00 / $35,982.80
| Facility | | $16,096.80 | $26,004.00 | $35,982.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,562.96 / $22,562.96 / $22,562.96
| Facility | | $22,562.96 | $22,562.96 | $22,562.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,857.71 / $23,807.38 / $36,068.69
| Facility | | $14,857.71 | $23,807.38 | $36,068.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $21,755.71 / $36,267.48
| Facility | | $7,516.00 | $21,755.71 | $36,267.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $21,755.71 / $35,180.11
| Facility | | $7,516.00 | $21,755.71 | $35,180.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,403.00 / $28,446.81 / $39,995.98
| Facility | | $10,403.00 | $28,446.81 | $39,995.98 |