- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,223.80 / $20,771.00 / $27,300.20
| Facility | | $14,223.80 | $20,771.00 | $27,300.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,554.49 / $15,126.97 / $25,585.23
| Facility | | $5,554.49 | $15,126.97 | $25,585.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,449.42 / $20,863.27 / $34,920.40
| Facility | | $14,449.42 | $20,863.27 | $34,920.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,891.59 / $23,283.68 / $33,996.08
| Facility | | $17,891.59 | $23,283.68 | $33,996.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,891.59 / $21,645.29 / $33,996.08
| Facility | | $17,891.59 | $21,645.29 | $33,996.08 |