- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.00 / $35,566.60 / $46,727.00
| Facility | | $5,767.00 | $35,566.60 | $46,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,153.10 / $35,820.85 / $60,586.14
| Facility | | $13,153.10 | $35,820.85 | $60,586.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,635.55 / $35,889.32 / $64,016.42
| Facility | | $25,635.55 | $35,889.32 | $64,016.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,636.21 / $39,869.22 / $58,212.31
| Facility | | $30,636.21 | $39,869.22 | $58,212.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,636.21 / $37,063.76 / $58,212.31
| Facility | | $30,636.21 | $37,063.76 | $58,212.31 |