- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $31,622.78 / $42,657.95
| Facility | | $19,952.62 | $31,622.78 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $42,657.95 / $52,480.75
| Facility | | $28,840.32 | $42,657.95 | $52,480.75 |
- 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
- $19,952.62 / $30,199.52 / $39,810.72
| Facility | | $19,952.62 | $30,199.52 | $39,810.72 |
- 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
- $16,595.87 / $28,840.32 / $43,651.58
| Facility | | $16,595.87 | $28,840.32 | $43,651.58 |