- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,490.80 / $25,299.20
| Facility | | $6,303.00 | $15,490.80 | $25,299.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,459.82 / $28,139.28 / $37,756.83
| Facility | | $20,459.82 | $28,139.28 | $37,756.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,763.25 / $23,020.39 / $32,270.81
| Facility | | $16,763.25 | $23,020.39 | $32,270.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,593.92 / $25,566.72 / $32,231.28
| Facility | | $14,593.92 | $25,566.72 | $32,231.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,593.92 / $25,779.55 / $33,804.69
| Facility | | $14,593.92 | $25,779.55 | $33,804.69 |