- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $20,991.40 / $34,282.50
| Facility | | $6,303.00 | $20,991.40 | $34,282.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,724.80 / $38,131.12 / $51,163.73
| Facility | | $27,724.80 | $38,131.12 | $51,163.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,715.62 / $31,194.58 / $43,729.68
| Facility | | $22,715.62 | $31,194.58 | $43,729.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,776.00 / $34,645.08 / $43,676.12
| Facility | | $19,776.00 | $34,645.08 | $43,676.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,776.00 / $34,933.48 / $45,808.22
| Facility | | $19,776.00 | $34,933.48 | $45,808.22 |