- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $19,498.45 / $20,892.96
| Facility | | $7,413.10 | $19,498.45 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $41,686.94 / $41,686.94
| Facility | | $41,686.94 | $41,686.94 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $21,877.62 / $37,153.52
| Facility | | $13,489.63 | $21,877.62 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $17,378.01 / $37,153.52
| Facility | | $12,022.64 | $17,378.01 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $15,488.17 / $30,199.52
| Facility | | $10,964.78 | $15,488.17 | $30,199.52 |