- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,281.80 / $16,580.20 / $25,598.40
| Facility | | $11,281.80 | $16,580.20 | $25,598.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,119.15 / $20,119.15 / $20,119.15
| Facility | | $20,119.15 | $20,119.15 | $20,119.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,105.83 / $4,629.54 / $90,634.97
| Facility | | $3,105.83 | $4,629.54 | $90,634.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,105.81 / $31,406.90 / $44,126.66
| Facility | | $16,105.81 | $31,406.90 | $44,126.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,281.80 / $16,958.70 / $27,117.70
| Facility | | $11,281.80 | $16,958.70 | $27,117.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.00 / $8,901.00 / $27,128.52
| Facility | | $1,312.00 | $8,901.00 | $27,128.52 |