- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $23,988.33 / $31,622.78
| Facility | | $14,791.08 | $23,988.33 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $33,884.42 / $41,686.94
| Facility | | $22,908.68 | $33,884.42 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $28,840.32 / $28,840.32
| Facility | | $28,840.32 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $22,908.68 / $30,902.95
| Facility | | $15,488.17 | $22,908.68 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $28,840.32 / $28,840.32
| Facility | | $28,840.32 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $20,417.38 / $33,113.11
| Facility | | $13,489.63 | $20,417.38 | $33,113.11 |