- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,608.30 / $28,757.40
| Facility | | $6,303.00 | $17,608.30 | $28,757.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,256.53 / $31,985.71 / $42,917.92
| Facility | | $23,256.53 | $31,985.71 | $42,917.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.66 / $26,167.10 / $36,681.98
| Facility | | $19,054.66 | $26,167.10 | $36,681.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,588.80 / $29,061.50 / $36,637.06
| Facility | | $16,588.80 | $29,061.50 | $36,637.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,588.80 / $29,303.42 / $38,425.54
| Facility | | $16,588.80 | $29,303.42 | $38,425.54 |