- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,821.00 / $20,975.10 / $38,326.10
| Facility | | $3,821.00 | $20,975.10 | $38,326.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,951.32 / $18,931.07 / $32,019.35
| Facility | | $6,951.32 | $18,931.07 | $32,019.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,307.83 / $30,766.00 / $51,495.33
| Facility | | $21,307.83 | $30,766.00 | $51,495.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,383.82 / $34,335.26 / $50,132.28
| Facility | | $26,383.82 | $34,335.26 | $50,132.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,383.82 / $31,919.20 / $50,132.28
| Facility | | $26,383.82 | $31,919.20 | $50,132.28 |