- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,179.20 / $30,928.00 / $40,650.00
| Facility | | $21,179.20 | $30,928.00 | $40,650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,300.35 / $30,775.12 / $52,051.97
| Facility | | $11,300.35 | $30,775.12 | $52,051.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,292.13 / $31,208.61 / $55,667.34
| Facility | | $22,292.13 | $31,208.61 | $55,667.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,640.61 / $34,669.44 / $50,620.21
| Facility | | $26,640.61 | $34,669.44 | $50,620.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,640.61 / $32,229.87 / $50,620.21
| Facility | | $26,640.61 | $32,229.87 | $50,620.21 |