- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,173.60 / $40,535.00 / $47,405.80
| Facility | | $26,173.60 | $40,535.00 | $47,405.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,729.42 / $38,949.62 / $54,937.61
| Facility | | $25,729.42 | $38,949.62 | $54,937.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,169.43 / $34,480.00 / $52,176.50
| Facility | | $24,169.43 | $34,480.00 | $52,176.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,832.00 / $33,636.00 / $48,884.00
| Facility | | $20,832.00 | $33,636.00 | $48,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $46,825.79 / $62,321.35
| Facility | | $5,274.00 | $46,825.79 | $62,321.35 |