- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $22,202.00 / $36,259.60
| Facility | | $6,303.00 | $22,202.00 | $36,259.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,323.68 / $40,330.12 / $54,114.33
| Facility | | $29,323.68 | $40,330.12 | $54,114.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,025.63 / $32,993.57 / $46,251.57
| Facility | | $24,025.63 | $32,993.57 | $46,251.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,916.48 / $36,643.06 / $46,194.92
| Facility | | $20,916.48 | $36,643.06 | $46,194.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,916.48 / $36,948.08 / $48,449.98
| Facility | | $20,916.48 | $36,948.08 | $48,449.98 |