- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,380.20 / $21,222.20 / $35,518.50
| Facility | | $15,380.20 | $21,222.20 | $35,518.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,654.71 / $22,654.71 / $22,654.71
| Facility | | $22,654.71 | $22,654.71 | $22,654.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,494.00 / $23,340.59 / $36,158.98
| Facility | | $3,494.00 | $23,340.59 | $36,158.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,868.45 / $23,875.91 / $40,039.76
| Facility | | $15,868.45 | $23,875.91 | $40,039.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $24,364.17 / $42,847.26
| Facility | | $4,062.00 | $24,364.17 | $42,847.26 |