- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $17,465.70 / $28,524.40
| Facility | | $6,303.00 | $17,465.70 | $28,524.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,068.11 / $31,726.57 / $42,570.21
| Facility | | $23,068.11 | $31,726.57 | $42,570.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,900.28 / $25,955.10 / $36,384.79
| Facility | | $18,900.28 | $25,955.10 | $36,384.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,454.40 / $28,826.05 / $36,340.23
| Facility | | $16,454.40 | $28,826.05 | $36,340.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,454.40 / $29,066.01 / $38,114.22
| Facility | | $16,454.40 | $29,066.01 | $38,114.22 |