- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,995.50 / $29,389.80
| Facility | | $6,303.00 | $17,995.50 | $29,389.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,767.96 / $32,689.10 / $43,861.72
| Facility | | $23,767.96 | $32,689.10 | $43,861.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,473.68 / $26,742.54 / $37,488.65
| Facility | | $19,473.68 | $26,742.54 | $37,488.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,953.59 / $29,700.59 / $37,442.73
| Facility | | $16,953.59 | $29,700.59 | $37,442.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,306.80 / $26,949.16 / $38,191.51
| Facility | | $17,306.80 | $26,949.16 | $38,191.51 |