- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,244.00 / $23,628.40 / $31,707.50
| Facility | | $14,244.00 | $23,628.40 | $31,707.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,854.36 / $15,748.32 / $20,321.59
| Facility | | $12,854.36 | $15,748.32 | $20,321.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,300.48 / $19,945.71 / $30,840.84
| Facility | | $11,300.48 | $19,945.71 | $30,840.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,696.26 / $19,024.50 / $43,630.79
| Facility | | $11,696.26 | $19,024.50 | $43,630.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,886.62 / $18,740.40 / $26,548.06
| Facility | | $13,886.62 | $18,740.40 | $26,548.06 |