- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $23,442.29 / $30,902.95
| Facility | | $14,454.40 | $23,442.29 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $20,417.38 / $23,442.29
| Facility | | $19,498.45 | $20,417.38 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $41,686.94 / $52,480.75
| Facility | | $28,840.32 | $41,686.94 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $27,542.29 / $27,542.29
| Facility | | $27,542.29 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $22,387.21 / $29,512.09
| Facility | | $14,791.08 | $22,387.21 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $27,542.29 / $27,542.29
| Facility | | $27,542.29 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $20,892.96 / $31,622.78
| Facility | | $12,022.64 | $20,892.96 | $31,622.78 |