- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,633.50 / $25,532.20
| Facility | | $6,303.00 | $15,633.50 | $25,532.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,648.25 / $28,398.43 / $38,104.56
| Facility | | $20,648.25 | $28,398.43 | $38,104.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,917.62 / $23,232.39 / $32,568.00
| Facility | | $16,917.62 | $23,232.39 | $32,568.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,728.32 / $25,802.18 / $32,528.11
| Facility | | $14,728.32 | $25,802.18 | $32,528.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,728.32 / $26,016.96 / $34,116.01
| Facility | | $14,728.32 | $26,016.96 | $34,116.01 |