- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,987.70 / $27,743.90
| Facility | | $6,303.00 | $16,987.70 | $27,743.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,436.90 / $30,858.44 / $41,405.36
| Facility | | $22,436.90 | $30,858.44 | $41,405.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,383.11 / $25,244.90 / $35,389.19
| Facility | | $18,383.11 | $25,244.90 | $35,389.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,004.16 / $28,037.29 / $35,345.85
| Facility | | $16,004.16 | $28,037.29 | $35,345.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,004.16 / $28,270.68 / $37,071.30
| Facility | | $16,004.16 | $28,270.68 | $37,071.30 |