- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,611.70 / $27,129.80
| Facility | | $6,303.00 | $16,611.70 | $27,129.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,940.27 / $30,175.41 / $40,488.89
| Facility | | $21,940.27 | $30,175.41 | $40,488.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,976.22 / $24,686.12 / $34,605.89
| Facility | | $17,976.22 | $24,686.12 | $34,605.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,649.92 / $27,416.70 / $34,563.50
| Facility | | $15,649.92 | $27,416.70 | $34,563.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,649.92 / $27,644.93 / $36,250.76
| Facility | | $15,649.92 | $27,644.93 | $36,250.76 |