- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,589.70 / $25,460.60
| Facility | | $6,303.00 | $15,589.70 | $25,460.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,590.37 / $28,318.83 / $37,997.76
| Facility | | $20,590.37 | $28,318.83 | $37,997.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,870.21 / $23,167.28 / $32,476.72
| Facility | | $16,870.21 | $23,167.28 | $32,476.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,687.04 / $25,609.00 / $32,436.94
| Facility | | $14,687.04 | $25,609.00 | $32,436.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,687.04 / $25,944.04 / $34,020.39
| Facility | | $14,687.04 | $25,944.04 | $34,020.39 |