- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,370.00 / $26,900.80 / $30,428.50
| Facility | | $17,370.00 | $26,900.80 | $30,428.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,248.43 / $26,110.96 / $36,828.94
| Facility | | $17,248.43 | $26,110.96 | $36,828.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,039.92 / $24,974.78 / $34,626.67
| Facility | | $16,039.92 | $24,974.78 | $34,626.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,886.00 / $25,025.00 / $32,171.00
| Facility | | $15,886.00 | $25,025.00 | $32,171.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $31,075.70 / $41,359.25
| Facility | | $5,274.00 | $31,075.70 | $41,359.25 |