- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,858.30 / $27,532.50
| Facility | | $6,303.00 | $16,858.30 | $27,532.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,265.97 / $30,623.36 / $41,089.94
| Facility | | $22,265.97 | $30,623.36 | $41,089.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,243.07 / $25,052.58 / $35,119.60
| Facility | | $18,243.07 | $25,052.58 | $35,119.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,882.24 / $27,823.70 / $35,076.58
| Facility | | $15,882.24 | $27,823.70 | $35,076.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,882.24 / $28,055.32 / $36,788.89
| Facility | | $15,882.24 | $28,055.32 | $36,788.89 |