- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,038.40 / $24,560.30
| Facility | | $6,303.00 | $15,038.40 | $24,560.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,862.25 / $27,317.43 / $36,654.08
| Facility | | $19,862.25 | $27,317.43 | $36,654.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,273.65 / $22,348.04 / $31,328.28
| Facility | | $16,273.65 | $22,348.04 | $31,328.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,167.68 / $24,820.00 / $31,289.91
| Facility | | $14,167.68 | $24,820.00 | $31,289.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,167.68 / $25,026.62 / $32,817.36
| Facility | | $14,167.68 | $25,026.62 | $32,817.36 |