- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $18,379.70 / $30,017.20
| Facility | | $6,303.00 | $18,379.70 | $30,017.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,275.35 / $33,386.94 / $44,798.06
| Facility | | $24,275.35 | $33,386.94 | $44,798.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,889.40 / $27,313.43 / $38,288.94
| Facility | | $19,889.40 | $27,313.43 | $38,288.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,315.52 / $30,334.63 / $38,242.05
| Facility | | $17,315.52 | $30,334.63 | $38,242.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,315.52 / $30,587.14 / $40,108.87
| Facility | | $17,315.52 | $30,587.14 | $40,108.87 |