- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,583.50 / $30,350.00
| Facility | | $6,303.00 | $18,583.50 | $30,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,544.52 / $33,757.14 / $45,294.80
| Facility | | $24,544.52 | $33,757.14 | $45,294.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,109.93 / $27,616.29 / $38,713.50
| Facility | | $20,109.93 | $27,616.29 | $38,713.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,507.52 / $30,670.99 / $38,666.08
| Facility | | $17,507.52 | $30,670.99 | $38,666.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,507.52 / $30,926.30 / $40,553.62
| Facility | | $17,507.52 | $30,926.30 | $40,553.62 |