- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $22,404.80 / $36,590.80
| Facility | | $6,303.00 | $22,404.80 | $36,590.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,591.51 / $40,698.49 / $54,608.58
| Facility | | $29,591.51 | $40,698.49 | $54,608.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,245.06 / $33,294.91 / $46,674.00
| Facility | | $24,245.06 | $33,294.91 | $46,674.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,107.52 / $36,977.74 / $46,616.84
| Facility | | $21,107.52 | $36,977.74 | $46,616.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,107.52 / $37,285.55 / $48,892.49
| Facility | | $21,107.52 | $37,285.55 | $48,892.49 |