- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,690.20 / $27,257.90
| Facility | | $6,303.00 | $16,690.20 | $27,257.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,043.91 / $30,317.94 / $40,680.12
| Facility | | $22,043.91 | $30,317.94 | $40,680.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,061.12 / $24,802.72 / $34,769.33
| Facility | | $18,061.12 | $24,802.72 | $34,769.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,723.84 / $27,546.20 / $34,726.76
| Facility | | $15,723.84 | $27,546.20 | $34,726.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,723.84 / $27,775.51 / $36,421.98
| Facility | | $15,723.84 | $27,775.51 | $36,421.98 |