- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,143.70 / $27,998.50
| Facility | | $6,303.00 | $17,143.70 | $27,998.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,642.82 / $31,141.64 / $41,785.37
| Facility | | $22,642.82 | $31,141.64 | $41,785.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,551.82 / $25,476.58 / $35,713.99
| Facility | | $18,551.82 | $25,476.58 | $35,713.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,151.04 / $28,294.60 / $35,670.24
| Facility | | $16,151.04 | $28,294.60 | $35,670.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,151.04 / $28,530.14 / $37,411.53
| Facility | | $16,151.04 | $28,530.14 | $37,411.53 |