- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,821.00 / $13,480.90 / $33,979.60
| Facility | | $3,821.00 | $13,480.90 | $33,979.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,911.00 / $21,544.63 / $36,439.83
| Facility | | $7,911.00 | $21,544.63 | $36,439.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,891.32 / $27,276.85 / $45,655.29
| Facility | | $18,891.32 | $27,276.85 | $45,655.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,391.65 / $30,441.33 / $44,446.82
| Facility | | $23,391.65 | $30,441.33 | $44,446.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,391.65 / $28,299.27 / $44,446.82
| Facility | | $23,391.65 | $28,299.27 | $44,446.82 |