- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $15,780.20 / $25,771.80
| Facility | | $6,303.00 | $15,780.20 | $25,771.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,114.15 / $28,664.97 / $38,462.21
| Facility | | $20,114.15 | $28,664.97 | $38,462.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,257.93 / $23,329.66 / $32,873.68
| Facility | | $10,257.93 | $23,329.66 | $32,873.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,866.56 / $24,460.14 / $32,833.42
| Facility | | $14,866.56 | $24,460.14 | $32,833.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,866.56 / $26,044.35 / $34,436.22
| Facility | | $14,866.56 | $26,044.35 | $34,436.22 |