- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,044.60 / $19,171.00 / $29,598.30
| Facility | | $13,044.60 | $19,171.00 | $29,598.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,076.02 / $32,806.01 / $42,058.99
| Facility | | $23,076.02 | $32,806.01 | $42,058.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,681.23 / $28,384.77 / $35,901.60
| Facility | | $14,681.23 | $28,384.77 | $35,901.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,044.60 / $19,608.59 / $31,354.90
| Facility | | $13,044.60 | $19,608.59 | $31,354.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,255.50 / $26,087.09 / $39,633.87
| Facility | | $15,255.50 | $26,087.09 | $39,633.87 |