- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $25,118.86 / $28,840.32
| Facility | | $19,498.45 | $25,118.86 | $28,840.32 |
- 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
- $18,620.87 / $21,877.62 / $26,915.35
| Facility | | $18,620.87 | $21,877.62 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $28,840.32 / $36,307.81
| Facility | | $17,782.79 | $28,840.32 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Facility | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $28,840.32 / $37,153.52
| Facility | | $1,862.09 | $28,840.32 | $37,153.52 |