- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $28,840.32 / $33,113.11
| Facility | | $22,387.21 | $28,840.32 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,113.11 / $33,113.11 / $33,113.11
| Facility | | $33,113.11 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $24,547.09 / $29,512.09
| Facility | | $20,892.96 | $24,547.09 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $33,113.11 / $40,738.03
| Facility | | $20,417.38 | $33,113.11 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,018.94 / $38,018.94 / $38,018.94
| Facility | | $38,018.94 | $38,018.94 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $32,359.37 / $42,657.95
| Facility | | $1,862.09 | $32,359.37 | $42,657.95 |