- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,641.60 / $25,545.50
| Facility | | $6,303.00 | $15,641.60 | $25,545.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,659.00 / $28,413.23 / $38,124.43
| Facility | | $20,659.00 | $28,413.23 | $38,124.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,926.45 / $23,244.51 / $32,584.98
| Facility | | $16,926.45 | $23,244.51 | $32,584.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,736.00 / $25,815.63 / $32,545.07
| Facility | | $14,736.00 | $25,815.63 | $32,545.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,736.00 / $26,030.53 / $34,133.80
| Facility | | $14,736.00 | $26,030.53 | $34,133.80 |