- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,288.00 / $29,867.40
| Facility | | $6,303.00 | $18,288.00 | $29,867.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,154.22 / $33,220.35 / $44,574.53
| Facility | | $24,154.22 | $33,220.35 | $44,574.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,790.16 / $27,177.14 / $38,097.89
| Facility | | $19,790.16 | $27,177.14 | $38,097.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,229.12 / $30,183.26 / $38,051.23
| Facility | | $17,229.12 | $30,183.26 | $38,051.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,229.12 / $30,434.52 / $39,908.74
| Facility | | $17,229.12 | $30,434.52 | $39,908.74 |