- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,966.10 / $24,442.10
| Facility | | $6,303.00 | $14,966.10 | $24,442.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,766.70 / $27,186.00 / $36,477.75
| Facility | | $19,766.70 | $27,186.00 | $36,477.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,195.35 / $22,240.52 / $31,177.56
| Facility | | $16,195.35 | $22,240.52 | $31,177.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,099.52 / $24,700.60 / $31,139.38
| Facility | | $14,099.52 | $24,700.60 | $31,139.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,099.52 / $24,906.21 / $32,659.48
| Facility | | $14,099.52 | $24,906.21 | $32,659.48 |