- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,627.30 / $30,421.60
| Facility | | $6,303.00 | $18,627.30 | $30,421.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,602.39 / $33,836.74 / $45,401.60
| Facility | | $24,602.39 | $33,836.74 | $45,401.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,157.36 / $27,681.40 / $38,804.78
| Facility | | $20,157.36 | $27,681.40 | $38,804.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,548.80 / $30,743.30 / $38,757.26
| Facility | | $17,548.80 | $30,743.30 | $38,757.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,914.40 / $27,895.28 / $39,532.33
| Facility | | $17,914.40 | $27,895.28 | $39,532.33 |