- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,971.60 / $21,863.00 / $28,735.50
| Facility | | $14,971.60 | $21,863.00 | $28,735.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,559.24 / $26,033.41 / $44,032.01
| Facility | | $9,559.24 | $26,033.41 | $44,032.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,758.29 / $22,061.34 / $40,059.64
| Facility | | $15,758.29 | $22,061.34 | $40,059.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,832.23 / $24,507.80 / $35,783.39
| Facility | | $18,832.23 | $24,507.80 | $35,783.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,832.23 / $22,783.27 / $35,783.39
| Facility | | $18,832.23 | $22,783.27 | $35,783.39 |