- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $22,526.00 / $36,788.80
| Facility | | $6,303.00 | $22,526.00 | $36,788.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,751.67 / $40,918.76 / $54,904.14
| Facility | | $29,751.67 | $40,918.76 | $54,904.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,376.29 / $33,475.12 / $46,926.62
| Facility | | $24,376.29 | $33,475.12 | $46,926.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,221.76 / $37,177.87 / $46,869.14
| Facility | | $21,221.76 | $37,177.87 | $46,869.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,221.76 / $37,487.35 / $49,157.11
| Facility | | $21,221.76 | $37,487.35 | $49,157.11 |