- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.00 / $14,425.00 / $23,558.40
| Facility | | $2,369.00 | $14,425.00 | $23,558.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,588.43 / $24,427.38 / $33,234.35
| Facility | | $16,588.43 | $24,427.38 | $33,234.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,465.43 / $19,147.41 / $30,050.36
| Facility | | $15,465.43 | $19,147.41 | $30,050.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,589.76 / $23,807.56 / $30,013.55
| Facility | | $13,589.76 | $23,807.56 | $30,013.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,589.76 / $24,005.74 / $31,478.70
| Facility | | $13,589.76 | $24,005.74 | $31,478.70 |