- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,511.20 / $18,245.50 / $29,618.20
| Facility | | $12,511.20 | $18,245.50 | $29,618.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,762.07 / $45,762.07 / $45,762.07
| Facility | | $45,762.07 | $45,762.07 | $45,762.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,085.77 / $32,819.87 / $42,076.75
| Facility | | $23,085.77 | $32,819.87 | $42,076.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,691.09 / $28,403.84 / $35,925.72
| Facility | | $14,691.09 | $28,403.84 | $35,925.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,053.40 / $19,621.70 / $31,376.00
| Facility | | $13,053.40 | $19,621.70 | $31,376.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,265.75 / $26,104.62 / $39,660.50
| Facility | | $15,265.75 | $26,104.62 | $39,660.50 |