- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,923.90 / $26,006.50
| Facility | | $6,303.00 | $15,923.90 | $26,006.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,031.82 / $28,925.97 / $38,812.40
| Facility | | $21,031.82 | $28,925.97 | $38,812.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,231.89 / $23,663.97 / $33,173.00
| Facility | | $17,231.89 | $23,663.97 | $33,173.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,001.92 / $26,281.49 / $33,132.37
| Facility | | $15,001.92 | $26,281.49 | $33,132.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,001.92 / $26,500.27 / $34,749.76
| Facility | | $15,001.92 | $26,500.27 | $34,749.76 |