- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,490.00 / $18,355.80 / $28,339.80
| Facility | | $12,490.00 | $18,355.80 | $28,339.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,624.64 / $32,164.30 / $41,236.28
| Facility | | $22,624.64 | $32,164.30 | $41,236.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,057.00 / $27,177.90 / $34,375.12
| Facility | | $14,057.00 | $27,177.90 | $34,375.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,490.00 / $18,774.80 / $30,021.80
| Facility | | $12,490.00 | $18,774.80 | $30,021.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,606.86 / $24,977.91 / $37,948.69
| Facility | | $14,606.86 | $24,977.91 | $37,948.69 |