- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,942.20 / $30,935.80
| Facility | | $6,303.00 | $18,942.20 | $30,935.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,018.27 / $34,408.69 / $46,169.05
| Facility | | $25,018.27 | $34,408.69 | $46,169.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,498.09 / $28,149.32 / $39,460.73
| Facility | | $20,498.09 | $28,149.32 | $39,460.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,845.43 / $31,262.98 / $39,412.40
| Facility | | $17,845.43 | $31,262.98 | $39,412.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,845.43 / $31,523.23 / $41,336.36
| Facility | | $17,845.43 | $31,523.23 | $41,336.36 |