- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,608.70 / $27,124.80
| Facility | | $6,303.00 | $16,608.70 | $27,124.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,936.24 / $30,169.86 / $40,481.44
| Facility | | $21,936.24 | $30,169.86 | $40,481.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,972.91 / $24,681.58 / $34,599.51
| Facility | | $17,972.91 | $24,681.58 | $34,599.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,647.04 / $27,411.66 / $34,557.14
| Facility | | $15,647.04 | $27,411.66 | $34,557.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,647.04 / $27,639.84 / $36,244.08
| Facility | | $15,647.04 | $27,639.84 | $36,244.08 |