- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,895.60 / $18,952.00 / $29,260.20
| Facility | | $12,895.60 | $18,952.00 | $29,260.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,422.35 / $28,422.35 / $30,363.03
| Facility | | $28,422.35 | $28,422.35 | $30,363.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,808.83 / $16,527.25 / $21,730.13
| Facility | | $11,808.83 | $16,527.25 | $21,730.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.54 / $28,060.58 / $35,491.55
| Facility | | $14,513.54 | $28,060.58 | $35,491.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,895.60 / $19,384.59 / $30,996.80
| Facility | | $12,895.60 | $19,384.59 | $30,996.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,081.26 / $25,789.14 / $39,181.19
| Facility | | $15,081.26 | $25,789.14 | $39,181.19 |