- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,373.30 / $23,808.60 / $27,844.20
| Facility | | $15,373.30 | $23,808.60 | $27,844.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,705.82 / $23,754.60 / $32,082.38
| Facility | | $15,705.82 | $23,754.60 | $32,082.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,186.54 / $19,704.00 / $29,852.45
| Facility | | $14,186.54 | $19,704.00 | $29,852.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,706.00 / $21,127.00 / $28,712.00
| Facility | | $14,706.00 | $21,127.00 | $28,712.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $22,204.24 / $36,517.16
| Facility | | $5,274.00 | $22,204.24 | $36,517.16 |