- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,647.70 / $30,454.90
| Facility | | $6,303.00 | $18,647.70 | $30,454.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,629.31 / $33,873.76 / $45,451.27
| Facility | | $24,629.31 | $33,873.76 | $45,451.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,179.41 / $27,711.69 / $38,847.24
| Facility | | $20,179.41 | $27,711.69 | $38,847.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,568.00 / $30,776.94 / $38,799.66
| Facility | | $17,568.00 | $30,776.94 | $38,799.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,568.00 / $31,033.14 / $40,693.71
| Facility | | $17,568.00 | $31,033.14 | $40,693.71 |