- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,821.00 / $33,101.40 / $43,199.70
| Facility | | $3,821.00 | $33,101.40 | $43,199.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,314.50 / $44,430.53 / $75,148.25
| Facility | | $16,314.50 | $44,430.53 | $75,148.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,884.65 / $34,678.26 / $58,043.59
| Facility | | $24,884.65 | $34,678.26 | $58,043.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,738.84 / $38,701.41 / $56,507.21
| Facility | | $29,738.84 | $38,701.41 | $56,507.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,738.84 / $35,978.12 / $56,507.21
| Facility | | $29,738.84 | $35,978.12 | $56,507.21 |