- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,812.80 / $25,825.10
| Facility | | $6,303.00 | $15,812.80 | $25,825.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,885.12 / $28,724.21 / $38,541.68
| Facility | | $20,885.12 | $28,724.21 | $38,541.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,111.70 / $23,498.91 / $32,941.61
| Facility | | $17,111.70 | $23,498.91 | $32,941.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,897.28 / $26,098.17 / $32,901.26
| Facility | | $14,897.28 | $26,098.17 | $32,901.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,404.72 / $24,510.68 / $33,559.23
| Facility | | $15,404.72 | $24,510.68 | $33,559.23 |