- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,821.00 / $32,035.70 / $54,182.10
| Facility | | $3,821.00 | $32,035.70 | $54,182.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,905.50 / $46,414.89 / $77,870.53
| Facility | | $16,905.50 | $46,414.89 | $77,870.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,007.00 / $40,625.72 / $69,684.50
| Facility | | $23,007.00 | $40,625.72 | $69,684.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,379.00 / $50,899.09 / $71,486.25
| Facility | | $23,379.00 | $50,899.09 | $71,486.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,379.00 / $44,780.69 / $71,486.25
| Facility | | $23,379.00 | $44,780.69 | $71,486.25 |