- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,275.60 / $19,510.40 / $30,122.40
| Facility | | $13,275.60 | $19,510.40 | $30,122.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,805.43 / $48,059.47 / $61,614.71
| Facility | | $33,805.43 | $48,059.47 | $61,614.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,941.20 / $28,887.41 / $36,537.35
| Facility | | $14,941.20 | $28,887.41 | $36,537.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,275.60 / $19,955.80 / $31,910.20
| Facility | | $13,275.60 | $19,955.80 | $31,910.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,472.45 / $26,549.04 / $40,335.71
| Facility | | $17,472.45 | $26,549.04 | $40,335.71 |