- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,658.70 / $16,315.40 / $33,157.19
| Facility | | $12,658.70 | $16,315.40 | $33,157.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,645.50 / $18,645.50 / $18,645.50
| Facility | | $18,645.50 | $18,645.50 | $18,645.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,948.27 / $16,230.93 / $18,556.15
| Facility | | $12,948.27 | $16,230.93 | $18,556.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,104.37 / $17,885.81 / $23,261.27
| Facility | | $10,104.37 | $17,885.81 | $23,261.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,442.33 / $21,442.33 / $21,442.33
| Facility | | $21,442.33 | $21,442.33 | $21,442.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $14,343.98 / $22,090.08
| Facility | | $1,286.00 | $14,343.98 | $22,090.08 |