- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,067.90 / $29,507.90
| Facility | | $6,303.00 | $18,067.90 | $29,507.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,863.51 / $32,820.51 / $44,038.06
| Facility | | $23,863.51 | $32,820.51 | $44,038.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,551.97 / $26,850.05 / $37,639.37
| Facility | | $19,551.97 | $26,850.05 | $37,639.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,021.75 / $29,820.00 / $37,593.26
| Facility | | $17,021.75 | $29,820.00 | $37,593.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,021.75 / $30,068.23 / $39,428.42
| Facility | | $17,021.75 | $30,068.23 | $39,428.42 |