- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.00 / $16,394.70 / $26,775.30
| Facility | | $2,369.00 | $16,394.70 | $26,775.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,099.05 / $28,635.20 / $37,772.50
| Facility | | $21,099.05 | $28,635.20 | $37,772.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,741.34 / $22,677.45 / $34,153.73
| Facility | | $17,741.34 | $22,677.45 | $34,153.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,445.44 / $27,058.48 / $34,111.90
| Facility | | $15,445.44 | $27,058.48 | $34,111.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,445.44 / $27,283.73 / $35,777.11
| Facility | | $15,445.44 | $27,283.73 | $35,777.11 |