- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,749.50 / $27,916.90 / $47,134.90
| Facility | | $12,749.50 | $27,916.90 | $47,134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,227.81 / $45,765.32 / $59,343.53
| Facility | | $31,227.81 | $45,765.32 | $59,343.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,830.11 / $39,795.97 / $58,418.26
| Facility | | $27,830.11 | $39,795.97 | $58,418.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,211.60 / $39,350.89 / $77,605.80
| Facility | | $22,211.60 | $39,350.89 | $77,605.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,341.09 / $16,341.09 / $16,341.09
| Facility | | $16,341.09 | $16,341.09 | $16,341.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,830.11 / $43,328.27 / $58,740.32
| Facility | | $27,830.11 | $43,328.27 | $58,740.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,062.77 / $35,895.00 / $55,088.68
| Facility | | $8,062.77 | $35,895.00 | $55,088.68 |