- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $21,813.70 / $35,625.50
| Facility | | $6,303.00 | $21,813.70 | $35,625.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,810.91 / $39,624.89 / $53,168.05
| Facility | | $28,810.91 | $39,624.89 | $53,168.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,605.50 / $32,416.62 / $45,442.78
| Facility | | $23,605.50 | $32,416.62 | $45,442.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,550.72 / $36,002.29 / $45,387.12
| Facility | | $20,550.72 | $36,002.29 | $45,387.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,550.72 / $36,301.99 / $47,602.75
| Facility | | $20,550.72 | $36,301.99 | $47,602.75 |