- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,748.30 / $27,352.80
| Facility | | $6,303.00 | $16,748.30 | $27,352.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,120.62 / $30,423.45 / $40,821.69
| Facility | | $22,120.62 | $30,423.45 | $40,821.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,123.98 / $24,889.03 / $34,890.33
| Facility | | $18,123.98 | $24,889.03 | $34,890.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,778.56 / $27,642.06 / $34,847.61
| Facility | | $15,778.56 | $27,642.06 | $34,847.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,778.56 / $27,872.17 / $36,548.73
| Facility | | $15,778.56 | $27,872.17 | $36,548.73 |