- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,296.90 / $26,615.60
| Facility | | $6,303.00 | $16,296.90 | $26,615.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,524.40 / $29,603.44 / $39,721.43
| Facility | | $21,524.40 | $29,603.44 | $39,721.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,635.48 / $24,218.20 / $33,949.94
| Facility | | $17,635.48 | $24,218.20 | $33,949.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,353.28 / $26,897.03 / $33,908.36
| Facility | | $15,353.28 | $26,897.03 | $33,908.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,353.28 / $27,120.93 / $35,563.62
| Facility | | $15,353.28 | $27,120.93 | $35,563.62 |