- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.00 / $32,896.40 / $45,096.40
| Facility | | $5,767.00 | $32,896.40 | $45,096.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,970.19 / $38,355.83 / $64,349.82
| Facility | | $13,970.19 | $38,355.83 | $64,349.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,730.50 / $34,622.28 / $61,756.37
| Facility | | $24,730.50 | $34,622.28 | $61,756.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,554.62 / $38,461.67 / $56,157.17
| Facility | | $29,554.62 | $38,461.67 | $56,157.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,554.62 / $35,755.25 / $56,157.17
| Facility | | $29,554.62 | $35,755.25 | $56,157.17 |