- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,736.00 / $22,979.30 / $30,202.70
| Facility | | $15,736.00 | $22,979.30 | $30,202.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,331.28 / $25,412.60 / $42,981.98
| Facility | | $9,331.28 | $25,412.60 | $42,981.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,562.91 / $23,187.79 / $41,360.46
| Facility | | $16,562.91 | $23,187.79 | $41,360.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,793.79 / $25,759.16 / $37,610.48
| Facility | | $19,793.79 | $25,759.16 | $37,610.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,793.79 / $23,946.58 / $37,610.48
| Facility | | $19,793.79 | $23,946.58 | $37,610.48 |