- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,781.30 / $25,989.10 / $30,394.30
| Facility | | $16,781.30 | $25,989.10 | $30,394.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,822.65 / $25,466.41 / $35,919.83
| Facility | | $16,822.65 | $25,466.41 | $35,919.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,496.30 / $23,912.43 / $34,480.00
| Facility | | $15,496.30 | $23,912.43 | $34,480.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,886.00 / $24,961.00 / $30,598.00
| Facility | | $15,886.00 | $24,961.00 | $30,598.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $30,022.49 / $39,957.51
| Facility | | $5,274.00 | $30,022.49 | $39,957.51 |