- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $21,714.90 / $35,464.10
| Facility | | $6,303.00 | $21,714.90 | $35,464.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,680.36 / $39,445.33 / $52,927.14
| Facility | | $28,680.36 | $39,445.33 | $52,927.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,498.54 / $32,269.73 / $45,236.87
| Facility | | $23,498.54 | $32,269.73 | $45,236.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,457.59 / $35,839.16 / $45,181.46
| Facility | | $20,457.59 | $35,839.16 | $45,181.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,457.59 / $36,137.50 / $47,387.05
| Facility | | $20,457.59 | $36,137.50 | $47,387.05 |