- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.00 / $26,425.50 / $34,732.10
| Facility | | $5,767.00 | $26,425.50 | $34,732.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,206.53 / $27,796.22 / $47,013.57
| Facility | | $10,206.53 | $27,796.22 | $47,013.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,046.82 / $26,665.22 / $47,563.22
| Facility | | $19,046.82 | $26,665.22 | $47,563.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,762.24 / $29,622.22 / $43,250.86
| Facility | | $22,762.24 | $29,622.22 | $43,250.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,762.24 / $27,537.80 / $43,250.86
| Facility | | $22,762.24 | $27,537.80 | $43,250.86 |