- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,237.40 / $28,151.60
| Facility | | $6,303.00 | $17,237.40 | $28,151.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,766.64 / $31,311.94 / $42,013.86
| Facility | | $22,766.64 | $31,311.94 | $42,013.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,653.27 / $25,615.90 / $35,909.28
| Facility | | $18,653.27 | $25,615.90 | $35,909.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,239.36 / $28,449.33 / $35,865.30
| Facility | | $16,239.36 | $28,449.33 | $35,865.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,239.36 / $28,686.15 / $37,616.11
| Facility | | $16,239.36 | $28,686.15 | $37,616.11 |