- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,705.09 / $28,915.50
| Facility | | $6,303.00 | $17,705.09 | $28,915.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,384.39 / $32,161.56 / $43,153.87
| Facility | | $23,384.39 | $32,161.56 | $43,153.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,159.41 / $26,310.96 / $36,883.65
| Facility | | $19,159.41 | $26,310.96 | $36,883.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,680.00 / $29,221.28 / $36,838.48
| Facility | | $16,680.00 | $29,221.28 | $36,838.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,680.00 / $29,464.53 / $38,636.79
| Facility | | $16,680.00 | $29,464.53 | $38,636.79 |