- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,020.00 / $18,987.50 / $30,822.70
| Facility | | $13,020.00 | $18,987.50 | $30,822.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,806.49 / $32,422.83 / $41,567.73
| Facility | | $22,806.49 | $32,422.83 | $41,567.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,288.54 / $29,558.96 / $37,386.73
| Facility | | $15,288.54 | $29,558.96 | $37,386.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,584.20 / $20,419.70 / $32,652.00
| Facility | | $13,584.20 | $20,419.70 | $32,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,886.57 / $27,166.23 / $41,273.40
| Facility | | $15,886.57 | $27,166.23 | $41,273.40 |