- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,964.00 / $24,438.80
| Facility | | $6,303.00 | $14,964.00 | $24,438.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,764.00 / $27,182.30 / $36,472.78
| Facility | | $19,764.00 | $27,182.30 | $36,472.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,193.15 / $22,237.50 / $31,173.32
| Facility | | $16,193.15 | $22,237.50 | $31,173.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,097.60 / $24,697.23 / $31,135.14
| Facility | | $14,097.60 | $24,697.23 | $31,135.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,097.60 / $24,902.82 / $32,655.03
| Facility | | $14,097.60 | $24,902.82 | $32,655.03 |