- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,066.70 / $20,370.50 / $35,846.30
| Facility | | $12,066.70 | $20,370.50 | $35,846.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,620.41 / $20,620.41 / $20,620.41
| Facility | | $20,620.41 | $20,620.41 | $20,620.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,525.60 / $9,710.68 / $15,404.30
| Facility | | $6,525.60 | $9,710.68 | $15,404.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,976.53 / $18,697.63 / $25,927.20
| Facility | | $10,976.53 | $18,697.63 | $25,927.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,267.04 / $36,315.60 / $42,619.44
| Facility | | $17,267.04 | $36,315.60 | $42,619.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.00 / $18,156.00 / $28,719.17
| Facility | | $3,158.00 | $18,156.00 | $28,719.17 |