- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $19,994.80 / $32,654.90
| Facility | | $6,303.00 | $19,994.80 | $32,654.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,408.54 / $36,320.81 / $48,734.69
| Facility | | $26,408.54 | $36,320.81 | $48,734.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,637.18 / $29,713.59 / $41,653.58
| Facility | | $21,637.18 | $29,713.59 | $41,653.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,837.12 / $33,000.28 / $41,602.56
| Facility | | $18,837.12 | $33,000.28 | $41,602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,837.12 / $33,274.99 / $43,633.44
| Facility | | $18,837.12 | $33,274.99 | $43,633.44 |