- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,276.80 / $19,362.00 / $31,430.60
| Facility | | $13,276.80 | $19,362.00 | $31,430.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,648.10 / $26,395.68 / $39,443.86
| Facility | | $25,648.10 | $26,395.68 | $39,443.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,154.16 / $34,338.74 / $44,024.03
| Facility | | $24,154.16 | $34,338.74 | $44,024.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,590.08 / $30,141.97 / $38,124.12
| Facility | | $15,590.08 | $30,141.97 | $38,124.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,852.10 / $20,822.40 / $33,296.00
| Facility | | $13,852.10 | $20,822.40 | $33,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,020.49 / $27,702.04 / $42,087.46
| Facility | | $15,020.49 | $27,702.04 | $42,087.46 |