- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.00 / $34,526.50 / $49,421.00
| Facility | | $5,767.00 | $34,526.50 | $49,421.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,519.91 / $38,569.62 / $66,881.99
| Facility | | $14,519.91 | $38,569.62 | $66,881.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,885.82 / $34,839.72 / $62,144.22
| Facility | | $24,885.82 | $34,839.72 | $62,144.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,740.24 / $38,703.22 / $56,509.86
| Facility | | $29,740.24 | $38,703.22 | $56,509.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,740.24 / $35,979.80 / $56,509.86
| Facility | | $29,740.24 | $35,979.80 | $56,509.86 |