- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,725.90 / $27,316.20
| Facility | | $6,303.00 | $16,725.90 | $27,316.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,091.01 / $30,382.72 / $40,767.06
| Facility | | $22,091.01 | $30,382.72 | $40,767.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,099.72 / $24,855.72 / $34,843.64
| Facility | | $18,099.72 | $24,855.72 | $34,843.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,757.44 / $27,605.07 / $34,800.96
| Facility | | $15,757.44 | $27,605.07 | $34,800.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,757.44 / $27,834.86 / $36,499.81
| Facility | | $15,757.44 | $27,834.86 | $36,499.81 |