- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,706.20 / $18,529.90 / $30,079.80
| Facility | | $12,706.20 | $18,529.90 | $30,079.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,815.52 / $20,815.52 / $20,815.52
| Facility | | $20,815.52 | $20,815.52 | $20,815.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,932.51 / $39,710.24 / $50,910.56
| Facility | | $27,932.51 | $39,710.24 | $50,910.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,920.06 / $28,846.55 / $36,485.66
| Facility | | $14,920.06 | $28,846.55 | $36,485.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,256.80 / $19,927.59 / $31,865.00
| Facility | | $13,256.80 | $19,927.59 | $31,865.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,503.68 / $26,511.49 / $40,278.65
| Facility | | $15,503.68 | $26,511.49 | $40,278.65 |