- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,717.20 / $38,768.80 / $60,932.00
| Facility | | $26,717.20 | $38,768.80 | $60,932.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,990.86 / $35,023.89 / $52,475.70
| Facility | | $21,990.86 | $35,023.89 | $52,475.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,397.44 / $33,736.76 / $62,821.28
| Facility | | $24,397.44 | $33,736.76 | $62,821.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.89 / $361.01 / $591.09
| Facility | | $189.89 | $361.01 | $591.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,900.88 / $38,613.72 / $63,549.18
| Facility | | $27,900.88 | $38,613.72 | $63,549.18 |