- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $22,548.40 / $36,825.40
| Facility | | $6,303.00 | $22,548.40 | $36,825.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,781.28 / $40,959.48 / $54,958.78
| Facility | | $29,781.28 | $40,959.48 | $54,958.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,400.55 / $33,508.43 / $46,973.32
| Facility | | $24,400.55 | $33,508.43 | $46,973.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,242.88 / $37,214.87 / $46,915.79
| Facility | | $21,242.88 | $37,214.87 | $46,915.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,242.88 / $37,524.66 / $49,206.03
| Facility | | $21,242.88 | $37,524.66 | $49,206.03 |