- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $39,810.72 / $42,657.95
| Facility | | $23,442.29 | $39,810.72 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $38,904.51 / $54,954.09
| Facility | | $26,302.68 | $38,904.51 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $33,884.42 / $47,863.01
| Facility | | $21,877.62 | $33,884.42 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $30,902.95 / $42,657.95
| Facility | | $20,892.96 | $30,902.95 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $30,902.95 / $56,234.13
| Facility | | $4,466.84 | $30,902.95 | $56,234.13 |