- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,347.80 / $26,698.80
| Facility | | $6,303.00 | $16,347.80 | $26,698.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,591.70 / $29,695.99 / $39,845.61
| Facility | | $21,591.70 | $29,695.99 | $39,845.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,690.62 / $24,293.91 / $34,056.08
| Facility | | $17,690.62 | $24,293.91 | $34,056.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,401.28 / $26,981.12 / $34,014.37
| Facility | | $15,401.28 | $26,981.12 | $34,014.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,401.28 / $27,205.72 / $35,674.82
| Facility | | $15,401.28 | $27,205.72 | $35,674.82 |