- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $22,387.21 / $29,512.09
| Facility | | $13,803.84 | $22,387.21 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $38,018.94 / $47,863.01
| Facility | | $26,302.68 | $38,018.94 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $26,915.35
| Facility | | $26,915.35 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $20,892.96 / $28,183.83
| Facility | | $14,125.38 | $20,892.96 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $26,915.35
| Facility | | $26,915.35 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $19,498.45 / $30,902.95
| Facility | | $12,302.69 | $19,498.45 | $30,902.95 |