- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,991.40 / $19,092.80 / $29,477.60
| Facility | | $12,991.40 | $19,092.80 | $29,477.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,924.85 / $19,796.25 / $25,379.81
| Facility | | $13,924.85 | $19,796.25 | $25,379.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,621.34 / $28,512.13 / $35,755.16
| Facility | | $14,621.34 | $28,512.13 | $35,755.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,991.40 / $19,528.59 / $31,227.00
| Facility | | $12,991.40 | $19,528.59 | $31,227.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,098.40 / $25,980.68 / $39,472.21
| Facility | | $17,098.40 | $25,980.68 | $39,472.21 |