- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,716.00 / $30,566.40
| Facility | | $6,303.00 | $18,716.00 | $30,566.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,719.48 / $33,997.78 / $45,617.68
| Facility | | $24,719.48 | $33,997.78 | $45,617.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,253.29 / $27,813.15 / $38,989.47
| Facility | | $20,253.29 | $27,813.15 | $38,989.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,632.32 / $30,889.62 / $38,941.71
| Facility | | $17,632.32 | $30,889.62 | $38,941.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,632.32 / $31,146.76 / $40,842.69
| Facility | | $17,632.32 | $31,146.76 | $40,842.69 |