- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,123.60 / $26,332.60
| Facility | | $6,303.00 | $16,123.60 | $26,332.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,295.61 / $29,288.77 / $39,299.21
| Facility | | $21,295.61 | $29,288.77 | $39,299.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,448.02 / $23,960.77 / $33,589.06
| Facility | | $17,448.02 | $23,960.77 | $33,589.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,190.08 / $26,611.12 / $33,547.92
| Facility | | $15,190.08 | $26,611.12 | $33,547.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,190.08 / $26,832.64 / $35,185.61
| Facility | | $15,190.08 | $26,832.64 | $35,185.61 |