- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,605.30 / $28,752.40
| Facility | | $6,303.00 | $17,605.30 | $28,752.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,252.49 / $31,980.16 / $42,910.47
| Facility | | $23,252.49 | $31,980.16 | $42,910.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,051.34 / $26,162.56 / $36,675.62
| Facility | | $19,051.34 | $26,162.56 | $36,675.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,585.91 / $29,056.46 / $36,630.69
| Facility | | $16,585.91 | $29,056.46 | $36,630.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,585.91 / $29,298.34 / $38,418.86
| Facility | | $16,585.91 | $29,298.34 | $38,418.86 |