- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,000.59 / $29,398.10
| Facility | | $6,303.00 | $18,000.59 | $29,398.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,774.69 / $32,698.36 / $43,874.14
| Facility | | $23,774.69 | $32,698.36 | $43,874.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,479.20 / $26,750.11 / $37,499.26
| Facility | | $19,479.20 | $26,750.11 | $37,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,958.40 / $29,709.00 / $37,453.33
| Facility | | $16,958.40 | $29,709.00 | $37,453.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,958.40 / $29,956.31 / $39,281.66
| Facility | | $16,958.40 | $29,956.31 | $39,281.66 |