- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,513.20 / $23,865.90 / $34,713.50
| Facility | | $16,513.20 | $23,865.90 | $34,713.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,625.00 / $22,966.10 / $34,403.50
| Facility | | $14,625.00 | $22,966.10 | $34,403.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,251.09 / $17,432.52 / $21,278.05
| Facility | | $14,251.09 | $17,432.52 | $21,278.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $261.82 / $1,105.04
| Facility | | $150.00 | $261.82 | $1,105.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,930.58 / $24,399.30 / $39,387.12
| Facility | | $16,930.58 | $24,399.30 | $39,387.12 |