- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,785.40 / $18,645.40 / $30,267.30
| Facility | | $12,785.40 | $18,645.40 | $30,267.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,809.31 / $40,956.73 / $52,508.63
| Facility | | $28,809.31 | $40,956.73 | $52,508.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,013.06 / $29,026.35 / $36,713.08
| Facility | | $15,013.06 | $29,026.35 | $36,713.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,339.40 / $20,051.80 / $32,063.70
| Facility | | $13,339.40 | $20,051.80 | $32,063.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,600.32 / $26,676.74 / $40,529.72
| Facility | | $15,600.32 | $26,676.74 | $40,529.72 |