- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,773.80 / $27,394.40
| Facility | | $6,303.00 | $16,773.80 | $27,394.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,154.27 / $30,469.72 / $40,883.79
| Facility | | $22,154.27 | $30,469.72 | $40,883.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,151.54 / $24,926.89 / $34,943.41
| Facility | | $18,151.54 | $24,926.89 | $34,943.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,802.56 / $27,684.11 / $34,900.61
| Facility | | $15,802.56 | $27,684.11 | $34,900.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,802.56 / $27,914.56 / $36,604.33
| Facility | | $15,802.56 | $27,914.56 | $36,604.33 |