- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,895.70 / $29,226.70
| Facility | | $6,303.00 | $17,895.70 | $29,226.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,636.06 / $32,507.70 / $43,618.32
| Facility | | $23,636.06 | $32,507.70 | $43,618.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,365.62 / $26,594.14 / $37,280.61
| Facility | | $19,365.62 | $26,594.14 | $37,280.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,859.52 / $29,535.77 / $37,234.94
| Facility | | $16,859.52 | $29,535.77 | $37,234.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,859.52 / $29,781.64 / $39,052.62
| Facility | | $16,859.52 | $29,781.64 | $39,052.62 |