- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,873.60 / $24,572.00 / $27,807.20
| Facility | | $15,873.60 | $24,572.00 | $27,807.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,877.88 / $20,989.89 / $28,868.88
| Facility | | $13,877.88 | $20,989.89 | $28,868.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,658.13 / $22,619.05 / $33,482.00
| Facility | | $14,658.13 | $22,619.05 | $33,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,113.32 / $20,832.00 / $28,014.00
| Facility | | $14,113.32 | $20,832.00 | $28,014.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $28,398.62 / $37,796.28
| Facility | | $5,274.00 | $28,398.62 | $37,796.28 |