- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.00 / $26,289.40 / $38,552.00
| Facility | | $5,767.00 | $26,289.40 | $38,552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,693.39 / $26,398.75 / $44,649.93
| Facility | | $9,693.39 | $26,398.75 | $44,649.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,948.72 / $26,527.89 / $47,318.26
| Facility | | $18,948.72 | $26,527.89 | $47,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,645.01 / $29,469.66 / $43,028.11
| Facility | | $22,645.01 | $29,469.66 | $43,028.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,645.01 / $27,395.98 / $43,028.11
| Facility | | $22,645.01 | $27,395.98 | $43,028.11 |