- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,333.80 / $19,596.00 / $30,254.50
| Facility | | $13,333.80 | $19,596.00 | $30,254.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,699.72 / $35,114.33 / $45,018.39
| Facility | | $24,699.72 | $35,114.33 | $45,018.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,006.72 / $29,014.09 / $36,697.58
| Facility | | $15,006.72 | $29,014.09 | $36,697.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,333.80 / $20,043.30 / $32,050.10
| Facility | | $13,333.80 | $20,043.30 | $32,050.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,593.73 / $26,665.47 / $40,512.60
| Facility | | $15,593.73 | $26,665.47 | $40,512.60 |