- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,327.40 / $26,665.50
| Facility | | $6,303.00 | $16,327.40 | $26,665.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,564.78 / $29,658.97 / $39,795.94
| Facility | | $21,564.78 | $29,658.97 | $39,795.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,668.56 / $24,263.63 / $34,013.62
| Facility | | $17,668.56 | $24,263.63 | $34,013.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,382.08 / $26,947.48 / $33,971.96
| Facility | | $15,382.08 | $26,947.48 | $33,971.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,382.08 / $27,171.80 / $35,630.35
| Facility | | $15,382.08 | $27,171.80 | $35,630.35 |