- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,789.00 / $24,516.90 / $32,223.60
| Facility | | $16,789.00 | $24,516.90 | $32,223.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.08 / $12,832.76 / $21,704.89
| Facility | | $4,712.08 | $12,832.76 | $21,704.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,055.28 / $24,625.82 / $41,218.05
| Facility | | $17,055.28 | $24,625.82 | $41,218.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,118.22 / $27,482.74 / $40,127.04
| Facility | | $21,118.22 | $27,482.74 | $40,127.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,118.22 / $25,548.87 / $40,127.04
| Facility | | $21,118.22 | $25,548.87 | $40,127.04 |