- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,026.50 / $27,807.10
| Facility | | $6,303.00 | $17,026.50 | $27,807.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,488.04 / $30,928.78 / $41,499.74
| Facility | | $22,488.04 | $30,928.78 | $41,499.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,425.00 / $25,302.44 / $35,469.87
| Facility | | $18,425.00 | $25,302.44 | $35,469.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,040.64 / $28,101.20 / $35,426.42
| Facility | | $16,040.64 | $28,101.20 | $35,426.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,040.64 / $28,335.12 / $37,155.80
| Facility | | $16,040.64 | $28,335.12 | $37,155.80 |