- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,106.60 / $20,572.09 / $33,395.00
| Facility | | $14,106.60 | $20,572.09 | $33,395.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,575.70 / $42,046.27 / $53,905.47
| Facility | | $29,575.70 | $42,046.27 | $53,905.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,564.46 / $32,025.84 / $40,506.89
| Facility | | $16,564.46 | $32,025.84 | $40,506.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,717.90 / $22,123.90 / $35,377.00
| Facility | | $14,717.90 | $22,123.90 | $35,377.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,212.40 / $29,433.42 / $44,717.92
| Facility | | $17,212.40 | $29,433.42 | $44,717.92 |