- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,758.00 / $24,966.90 / $31,812.70
| Facility | | $15,758.00 | $24,966.90 | $31,812.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,959.54 / $27,187.46 / $38,347.32
| Facility | | $17,959.54 | $27,187.46 | $38,347.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,769.57 / $26,495.44 / $35,783.19
| Facility | | $16,769.57 | $26,495.44 | $35,783.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,191.00 / $25,651.00 / $32,050.00
| Facility | | $17,191.00 | $25,651.00 | $32,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $26,770.00 / $43,105.99
| Facility | | $5,274.00 | $26,770.00 | $43,105.99 |