- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $20,417.38 / $26,915.35
| Facility | | $12,589.25 | $20,417.38 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $30,199.52 / $37,153.52
| Facility | | $20,417.38 | $30,199.52 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $18,620.87 / $25,118.86
| Facility | | $12,882.50 | $18,620.87 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $17,378.01 / $27,542.29
| Facility | | $11,220.18 | $17,378.01 | $27,542.29 |