- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $23,988.33 / $34,673.69
| Facility | | $15,135.61 | $23,988.33 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $23,442.29
| Facility | | $23,442.29 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $28,183.83 / $37,153.52
| Facility | | $18,620.87 | $28,183.83 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $23,442.29 / $38,018.94
| Facility | | $15,135.61 | $23,442.29 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $20,892.96 / $38,018.94
| Facility | | $4,073.80 | $20,892.96 | $38,018.94 |