- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.00 / $19,790.80 / $32,723.20
| Facility | | $2,369.00 | $19,790.80 | $32,723.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,785.98 / $34,996.21 / $48,836.52
| Facility | | $25,785.98 | $34,996.21 | $48,836.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,682.39 / $28,658.82 / $41,740.62
| Facility | | $21,682.39 | $28,658.82 | $41,740.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,876.48 / $33,069.23 / $41,689.49
| Facility | | $18,876.48 | $33,069.23 | $41,689.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,876.48 / $33,344.51 / $43,724.61
| Facility | | $18,876.48 | $33,344.51 | $43,724.61 |