- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.00 / $21,816.10 / $39,862.80
| Facility | | $1,973.00 | $21,816.10 | $39,862.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,971.96 / $18,987.27 / $32,114.42
| Facility | | $6,971.96 | $18,987.27 | $32,114.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,233.80 / $37,613.35 / $59,785.35
| Facility | | $23,233.80 | $37,613.35 | $59,785.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,441.68 / $35,711.94 / $52,142.34
| Facility | | $27,441.68 | $35,711.94 | $52,142.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,441.68 / $33,199.01 / $52,142.34
| Facility | | $27,441.68 | $33,199.01 | $52,142.34 |