- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.00 / $17,850.70 / $32,617.20
| Facility | | $1,973.00 | $17,850.70 | $32,617.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,403.47 / $17,439.06 / $29,495.83
| Facility | | $6,403.47 | $17,439.06 | $29,495.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,010.75 / $30,776.65 / $48,918.60
| Facility | | $19,010.75 | $30,776.65 | $48,918.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,453.81 / $29,220.84 / $42,664.81
| Facility | | $22,453.81 | $29,220.84 | $42,664.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,453.81 / $27,164.67 / $42,664.81
| Facility | | $22,453.81 | $27,164.67 | $42,664.81 |