- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,468.60 / $18,183.40 / $29,517.30
| Facility | | $12,468.60 | $18,183.40 | $29,517.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,331.60 / $24,204.43 / $28,908.13
| Facility | | $22,331.60 | $24,204.43 | $28,908.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,009.02 / $41,240.66 / $52,872.64
| Facility | | $29,009.02 | $41,240.66 | $52,872.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,641.07 / $28,684.26 / $41,472.64
| Facility | | $14,641.07 | $28,684.26 | $41,472.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,008.90 / $19,554.90 / $31,269.20
| Facility | | $13,008.90 | $19,554.90 | $31,269.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,213.77 / $26,015.73 / $39,525.46
| Facility | | $15,213.77 | $26,015.73 | $39,525.46 |