- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $14,125.38 / $14,125.38
| Facility | | $13,803.84 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $29,512.09 / $43,651.58
| Facility | | $21,877.62 | $29,512.09 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $22,908.68 / $30,199.52
| Facility | | $12,022.64 | $22,908.68 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $25,703.96
| Facility | | $14,791.08 | $14,791.08 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $28,840.32 / $51,286.14
| Facility | | $28,840.32 | $28,840.32 | $51,286.14 |