- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.00 / $29,226.80 / $38,414.10
| Facility | | $5,767.00 | $29,226.80 | $38,414.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,852.86 / $27,051.53 / $45,384.51
| Facility | | $9,852.86 | $27,051.53 | $45,384.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,277.00 / $29,356.67 / $49,136.43
| Facility | | $21,277.00 | $29,356.67 | $49,136.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,175.23 / $32,762.43 / $47,835.82
| Facility | | $25,175.23 | $32,762.43 | $47,835.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,175.23 / $30,457.05 / $47,835.82
| Facility | | $25,175.23 | $30,457.05 | $47,835.82 |