- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,821.50 / $20,312.70 / $31,361.00
| Facility | | $13,821.50 | $20,312.70 | $31,361.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,082.12 / $29,082.12 / $29,082.12
| Facility | | $29,082.12 | $29,082.12 | $29,082.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,146.84 / $40,014.94 / $51,301.20
| Facility | | $28,146.84 | $40,014.94 | $51,301.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,555.56 / $30,075.22 / $38,039.71
| Facility | | $15,555.56 | $30,075.22 | $38,039.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,821.50 / $20,776.30 / $33,222.30
| Facility | | $13,821.50 | $20,776.30 | $33,222.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,164.04 / $27,640.70 / $41,994.26
| Facility | | $16,164.04 | $27,640.70 | $41,994.26 |