- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,110.80 / $24,678.40
| Facility | | $6,303.00 | $15,110.80 | $24,678.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,957.82 / $27,448.85 / $36,830.43
| Facility | | $19,957.82 | $27,448.85 | $36,830.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,351.94 / $22,455.55 / $31,479.00
| Facility | | $16,351.94 | $22,455.55 | $31,479.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,235.84 / $24,939.41 / $31,440.45
| Facility | | $14,235.84 | $24,939.41 | $31,440.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,235.84 / $25,147.02 / $32,975.25
| Facility | | $14,235.84 | $25,147.02 | $32,975.25 |