- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,042.10 / $26,199.50
| Facility | | $6,303.00 | $16,042.10 | $26,199.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,187.94 / $29,140.69 / $39,100.51
| Facility | | $21,187.94 | $29,140.69 | $39,100.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,359.81 / $23,839.62 / $33,419.24
| Facility | | $17,359.81 | $23,839.62 | $33,419.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,113.28 / $26,476.58 / $33,378.31
| Facility | | $15,113.28 | $26,476.58 | $33,378.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,113.28 / $26,696.98 / $35,007.71
| Facility | | $15,113.28 | $26,696.98 | $35,007.71 |