- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $39,810.72 / $42,657.95
| Facility | | $23,988.33 | $39,810.72 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $39,810.72 / $54,954.09
| Facility | | $26,915.35 | $39,810.72 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $32,359.37 / $48,977.88
| Facility | | $16,218.10 | $32,359.37 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $28,840.32 / $43,651.58
| Facility | | $15,488.17 | $28,840.32 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $38,018.94 / $57,543.99
| Facility | | $4,073.80 | $38,018.94 | $57,543.99 |