- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,838.40 / $21,685.10 / $30,703.70
| Facility | | $11,838.40 | $21,685.10 | $30,703.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,803.15 / $17,803.15 / $17,803.15
| Facility | | $17,803.15 | $17,803.15 | $17,803.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,578.44 / $19,943.57 / $31,470.57
| Facility | | $12,578.44 | $19,943.57 | $31,470.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,308.34 / $19,506.84 / $34,705.79
| Facility | | $12,308.34 | $19,506.84 | $34,705.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $18,189.78 / $41,039.66
| Facility | | $7,117.00 | $18,189.78 | $41,039.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $18,003.74 / $36,469.98
| Facility | | $3,308.00 | $18,003.74 | $36,469.98 |