- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,013.60 / $20,595.09 / $31,797.10
| Facility | | $14,013.60 | $20,595.09 | $31,797.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,796.92 / $45,204.07 / $57,953.93
| Facility | | $31,796.92 | $45,204.07 | $57,953.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,771.85 / $30,493.40 / $38,568.64
| Facility | | $15,771.85 | $30,493.40 | $38,568.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,013.60 / $21,065.20 / $33,684.19
| Facility | | $14,013.60 | $21,065.20 | $33,684.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,388.79 / $28,025.03 / $42,578.17
| Facility | | $16,388.79 | $28,025.03 | $42,578.17 |