- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $21,576.30 / $35,237.80
| Facility | | $6,303.00 | $21,576.30 | $35,237.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,497.32 / $39,193.60 / $52,589.36
| Facility | | $28,497.32 | $39,193.60 | $52,589.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,348.57 / $32,063.79 / $44,948.17
| Facility | | $23,348.57 | $32,063.79 | $44,948.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,327.04 / $35,610.43 / $44,893.11
| Facility | | $20,327.04 | $35,610.43 | $44,893.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,327.04 / $35,906.87 / $47,084.62
| Facility | | $20,327.04 | $35,906.87 | $47,084.62 |