- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,976.20 / $29,358.20
| Facility | | $6,303.00 | $17,976.20 | $29,358.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,742.39 / $32,653.93 / $43,814.53
| Facility | | $23,742.39 | $32,653.93 | $43,814.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,452.73 / $26,713.77 / $37,448.31
| Facility | | $19,452.73 | $26,713.77 | $37,448.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,935.36 / $29,668.63 / $37,402.44
| Facility | | $16,935.36 | $29,668.63 | $37,402.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,935.36 / $29,915.61 / $39,228.29
| Facility | | $16,935.36 | $29,915.61 | $39,228.29 |