- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,419.80 / $28,449.50
| Facility | | $6,303.00 | $17,419.80 | $28,449.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,007.55 / $31,643.27 / $42,458.44
| Facility | | $23,007.55 | $31,643.27 | $42,458.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,850.66 / $25,886.96 / $36,289.26
| Facility | | $18,850.66 | $25,886.96 | $36,289.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,411.20 / $28,750.37 / $36,244.82
| Facility | | $16,411.20 | $28,750.37 | $36,244.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,411.20 / $28,989.70 / $38,014.15
| Facility | | $16,411.20 | $28,989.70 | $38,014.15 |