- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,640.60 / $25,543.80
| Facility | | $6,303.00 | $15,640.60 | $25,543.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,657.66 / $28,411.38 / $38,121.94
| Facility | | $20,657.66 | $28,411.38 | $38,121.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,925.34 / $23,242.99 / $32,582.86
| Facility | | $16,925.34 | $23,242.99 | $32,582.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,735.04 / $25,813.95 / $32,542.95
| Facility | | $14,735.04 | $25,813.95 | $32,542.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,735.04 / $26,028.83 / $34,131.57
| Facility | | $14,735.04 | $26,028.83 | $34,131.57 |