- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,932.10 / $26,019.80
| Facility | | $6,303.00 | $15,932.10 | $26,019.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,042.58 / $28,940.78 / $38,832.26
| Facility | | $21,042.58 | $28,940.78 | $38,832.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,240.71 / $23,676.08 / $33,189.98
| Facility | | $17,240.71 | $23,676.08 | $33,189.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,009.60 / $26,294.94 / $33,149.33
| Facility | | $15,009.60 | $26,294.94 | $33,149.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,009.60 / $26,513.83 / $34,767.55
| Facility | | $15,009.60 | $26,513.83 | $34,767.55 |