- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $36,307.81 / $51,286.14
| Facility | | $28,183.83 | $36,307.81 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $37,153.52 / $43,651.58
| Facility | | $25,703.96 | $37,153.52 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $36,307.81 / $44,668.36
| Facility | | $22,908.68 | $36,307.81 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $19,952.62
| Facility | | $19,952.62 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $34,673.69 / $51,286.14
| Facility | | $19,952.62 | $34,673.69 | $51,286.14 |