- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,630.80 / $36,511.40 / $55,905.60
| Facility | | $28,630.80 | $36,511.40 | $55,905.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,964.66 / $32,697.96 / $42,498.40
| Facility | | $22,964.66 | $32,697.96 | $42,498.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,652.24 / $37,565.94 / $52,362.59
| Facility | | $24,652.24 | $37,565.94 | $52,362.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,264.00 / $15,264.00 / $15,264.00
| Facility | | $15,264.00 | $15,264.00 | $15,264.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,636.00 / $37,226.92 / $48,694.89
| Facility | | $8,636.00 | $37,226.92 | $48,694.89 |