- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,989.50 / $24,480.40
| Facility | | $6,303.00 | $14,989.50 | $24,480.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,797.66 / $27,228.58 / $36,534.87
| Facility | | $19,797.66 | $27,228.58 | $36,534.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,220.72 / $22,275.35 / $31,226.39
| Facility | | $16,220.72 | $22,275.35 | $31,226.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,121.60 / $24,739.28 / $31,188.14
| Facility | | $14,121.60 | $24,739.28 | $31,188.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,121.60 / $24,945.22 / $32,710.63
| Facility | | $14,121.60 | $24,945.22 | $32,710.63 |