- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,658.30 / $28,838.90
| Facility | | $6,303.00 | $17,658.30 | $28,838.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,322.48 / $32,076.41 / $43,039.62
| Facility | | $23,322.48 | $32,076.41 | $43,039.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,108.68 / $26,241.30 / $36,786.00
| Facility | | $19,108.68 | $26,241.30 | $36,786.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,635.84 / $29,143.91 / $36,740.94
| Facility | | $16,635.84 | $29,143.91 | $36,740.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,635.84 / $29,386.52 / $38,534.50
| Facility | | $16,635.84 | $29,386.52 | $38,534.50 |