- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $21,704.70 / $35,447.50
| Facility | | $6,303.00 | $21,704.70 | $35,447.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,666.90 / $39,426.83 / $52,902.30
| Facility | | $28,666.90 | $39,426.83 | $52,902.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,487.51 / $32,254.59 / $45,215.64
| Facility | | $23,487.51 | $32,254.59 | $45,215.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,448.00 / $35,822.33 / $45,160.26
| Facility | | $20,448.00 | $35,822.33 | $45,160.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,448.00 / $36,120.54 / $47,364.81
| Facility | | $20,448.00 | $36,120.54 | $47,364.81 |