- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,588.90 / $18,501.20 / $28,564.20
| Facility | | $12,588.90 | $18,501.20 | $28,564.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,695.77 / $26,925.29 / $39,137.56
| Facility | | $17,695.77 | $26,925.29 | $39,137.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,259.70 / $34,488.79 / $44,216.40
| Facility | | $24,259.70 | $34,488.79 | $44,216.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,168.32 / $27,393.12 / $34,647.33
| Facility | | $14,168.32 | $27,393.12 | $34,647.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,588.90 / $18,923.50 / $30,259.50
| Facility | | $12,588.90 | $18,923.50 | $30,259.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,722.53 / $25,175.71 / $38,249.22
| Facility | | $14,722.53 | $25,175.71 | $38,249.22 |