- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $22,112.30 / $36,113.10
| Facility | | $6,303.00 | $22,112.30 | $36,113.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,205.25 / $40,167.24 / $53,895.77
| Facility | | $29,205.25 | $40,167.24 | $53,895.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,928.59 / $32,860.31 / $46,064.76
| Facility | | $23,928.59 | $32,860.31 | $46,064.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,832.00 / $36,495.06 / $46,008.34
| Facility | | $20,832.00 | $36,495.06 | $46,008.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,832.00 / $36,798.86 / $48,254.29
| Facility | | $20,832.00 | $36,798.86 | $48,254.29 |