- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,670.80 / $31,603.30 / $51,302.00
| Facility | | $21,670.80 | $31,603.30 | $51,302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,317.33 / $40,257.31 / $51,611.94
| Facility | | $28,317.33 | $40,257.31 | $51,611.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,446.61 / $47,397.65 / $58,940.96
| Facility | | $25,446.61 | $47,397.65 | $58,940.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,609.90 / $33,987.00 / $54,346.80
| Facility | | $22,609.90 | $33,987.00 | $54,346.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,340.86 / $45,216.12 / $68,696.44
| Facility | | $27,340.86 | $45,216.12 | $68,696.44 |