- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,238.00 / $31,013.90 / $40,762.90
| Facility | | $21,238.00 | $31,013.90 | $40,762.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,200.96 / $38,674.56 / $65,412.81
| Facility | | $14,200.96 | $38,674.56 | $65,412.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,354.03 / $31,295.26 / $55,821.90
| Facility | | $22,354.03 | $31,295.26 | $55,821.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,714.58 / $34,765.69 / $50,760.76
| Facility | | $26,714.58 | $34,765.69 | $50,760.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,714.00 / $30,403.24 / $47,391.76
| Facility | | $17,714.00 | $30,403.24 | $47,391.76 |