- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,619.90 / $27,143.10
| Facility | | $6,303.00 | $16,619.90 | $27,143.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,951.04 / $30,190.22 / $40,508.76
| Facility | | $21,951.04 | $30,190.22 | $40,508.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,985.04 / $24,698.23 / $34,622.87
| Facility | | $17,985.04 | $24,698.23 | $34,622.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,657.60 / $27,430.16 / $34,580.46
| Facility | | $15,657.60 | $27,430.16 | $34,580.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,657.60 / $27,658.50 / $36,268.55
| Facility | | $15,657.60 | $27,658.50 | $36,268.55 |