- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,508.10 / $18,382.50 / $28,381.00
| Facility | | $12,508.10 | $18,382.50 | $28,381.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,299.45 / $22,004.69 / $24,141.03
| Facility | | $15,299.45 | $22,004.69 | $24,141.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,917.53 / $25,472.44 / $32,656.98
| Facility | | $17,917.53 | $25,472.44 | $32,656.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,077.43 / $27,217.40 / $34,425.08
| Facility | | $14,077.43 | $27,217.40 | $34,425.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,508.10 / $18,802.09 / $30,065.40
| Facility | | $12,508.10 | $18,802.09 | $30,065.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,628.09 / $25,014.21 / $38,003.86
| Facility | | $14,628.09 | $25,014.21 | $38,003.86 |