- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,693.40 / $18,654.80 / $28,801.40
| Facility | | $12,693.40 | $18,654.80 | $28,801.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,397.32 / $31,841.13 / $40,821.96
| Facility | | $22,397.32 | $31,841.13 | $40,821.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,285.98 / $27,620.60 / $34,935.06
| Facility | | $14,285.98 | $27,620.60 | $34,935.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,693.40 / $19,080.70 / $30,510.80
| Facility | | $12,693.40 | $19,080.70 | $30,510.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,844.79 / $25,384.78 / $38,566.85
| Facility | | $14,844.79 | $25,384.78 | $38,566.85 |