- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,982.90 / $30,083.80 / $49,946.20
| Facility | | $18,982.90 | $30,083.80 | $49,946.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,948.88 / $20,948.88 / $20,948.88
| Facility | | $20,948.88 | $20,948.88 | $20,948.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,672.52 / $25,522.98 / $43,137.61
| Facility | | $16,672.52 | $25,522.98 | $43,137.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,931.28 / $32,884.80 / $57,433.63
| Facility | | $25,931.28 | $32,884.80 | $57,433.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,503.57 / $32,214.21 / $74,552.92
| Facility | | $15,503.57 | $32,214.21 | $74,552.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,120.00 / $28,446.00 / $42,675.44
| Facility | | $16,120.00 | $28,446.00 | $42,675.44 |