- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,267.30 / $26,567.30
| Facility | | $6,303.00 | $16,267.30 | $26,567.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,485.37 / $29,549.76 / $39,649.40
| Facility | | $21,485.37 | $29,549.76 | $39,649.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,603.50 / $24,174.29 / $33,888.37
| Facility | | $17,603.50 | $24,174.29 | $33,888.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,325.44 / $26,848.26 / $33,846.87
| Facility | | $15,325.44 | $26,848.26 | $33,846.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,325.44 / $27,071.75 / $35,499.15
| Facility | | $15,325.44 | $27,071.75 | $35,499.15 |