- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,639.30 / $20,045.00 / $30,947.70
| Facility | | $13,639.30 | $20,045.00 | $30,947.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,286.50 / $28,840.30 / $36,974.74
| Facility | | $20,286.50 | $28,840.30 | $36,974.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,350.54 / $29,678.83 / $37,538.35
| Facility | | $15,350.54 | $29,678.83 | $37,538.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,639.30 / $20,502.50 / $32,784.40
| Facility | | $13,639.30 | $20,502.50 | $32,784.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,767.04 / $27,276.40 / $41,440.78
| Facility | | $16,767.04 | $27,276.40 | $41,440.78 |