- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,877.60 / $39,001.60 / $58,956.00
| Facility | | $26,877.60 | $39,001.60 | $58,956.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,122.87 / $35,234.14 / $52,790.72
| Facility | | $22,122.87 | $35,234.14 | $52,790.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,483.14 / $35,744.51 / $63,676.00
| Facility | | $25,483.14 | $35,744.51 | $63,676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.03 / $363.18 / $594.64
| Facility | | $191.03 | $363.18 | $594.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,068.38 / $38,845.54 / $63,930.70
| Facility | | $28,068.38 | $38,845.54 | $63,930.70 |