- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,980.70 / $20,995.80 / $28,287.40
| Facility | | $12,980.70 | $20,995.80 | $28,287.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,643.50 / $20,643.50 / $20,643.50
| Facility | | $20,643.50 | $20,643.50 | $20,643.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,159.16 / $17,880.97 / $27,090.06
| Facility | | $11,159.16 | $17,880.97 | $27,090.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $17,103.00 / $29,279.40
| Facility | | $7,516.00 | $17,103.00 | $29,279.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $17,103.00 / $27,593.83
| Facility | | $7,516.00 | $17,103.00 | $27,593.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,403.00 / $21,583.42 / $30,421.53
| Facility | | $10,403.00 | $21,583.42 | $30,421.53 |