- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.00 / $26,942.30 / $35,714.00
| Facility | | $5,767.00 | $26,942.30 | $35,714.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,517.04 / $27,936.69 / $48,443.85
| Facility | | $10,517.04 | $27,936.69 | $48,443.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,419.34 / $27,186.75 / $48,493.49
| Facility | | $19,419.34 | $27,186.75 | $48,493.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,207.43 / $30,201.59 / $44,096.78
| Facility | | $23,207.43 | $30,201.59 | $44,096.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,207.43 / $28,076.40 / $44,096.78
| Facility | | $23,207.43 | $28,076.40 | $44,096.78 |