- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,155.50 / $29,651.10
| Facility | | $6,303.00 | $18,155.50 | $29,651.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,979.26 / $32,979.71 / $44,251.66
| Facility | | $23,979.26 | $32,979.71 | $44,251.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,646.81 / $26,980.28 / $37,821.93
| Facility | | $19,646.81 | $26,980.28 | $37,821.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,104.32 / $29,964.63 / $37,775.60
| Facility | | $17,104.32 | $29,964.63 | $37,775.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,104.32 / $30,214.07 / $39,619.66
| Facility | | $17,104.32 | $30,214.07 | $39,619.66 |