- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $21,308.30 / $34,800.10
| Facility | | $6,303.00 | $21,308.30 | $34,800.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,143.36 / $38,706.78 / $51,936.15
| Facility | | $28,143.36 | $38,706.78 | $51,936.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,058.56 / $31,665.53 / $44,389.87
| Facility | | $23,058.56 | $31,665.53 | $44,389.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,074.56 / $35,168.12 / $44,335.50
| Facility | | $20,074.56 | $35,168.12 | $44,335.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,074.56 / $35,460.87 / $46,499.79
| Facility | | $20,074.56 | $35,460.87 | $46,499.79 |