- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,964.30 / $27,705.60
| Facility | | $6,303.00 | $16,964.30 | $27,705.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,405.94 / $30,815.86 / $41,348.24
| Facility | | $22,405.94 | $30,815.86 | $41,348.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,357.75 / $25,210.07 / $35,340.37
| Facility | | $18,357.75 | $25,210.07 | $35,340.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,982.08 / $27,998.61 / $35,297.08
| Facility | | $15,982.08 | $27,998.61 | $35,297.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,982.08 / $28,231.68 / $37,020.16
| Facility | | $15,982.08 | $28,231.68 | $37,020.16 |