- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $19,505.70 / $31,856.10
| Facility | | $6,303.00 | $19,505.70 | $31,856.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,762.53 / $35,432.32 / $47,542.53
| Facility | | $25,762.53 | $35,432.32 | $47,542.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,107.88 / $28,986.73 / $40,634.64
| Facility | | $21,107.88 | $28,986.73 | $40,634.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,376.32 / $32,193.02 / $40,584.87
| Facility | | $18,376.32 | $32,193.02 | $40,584.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,376.32 / $32,461.00 / $42,566.07
| Facility | | $18,376.32 | $32,461.00 | $42,566.07 |