- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,707.20 / $31,896.90 / $31,896.90
| Facility | | $28,707.20 | $31,896.90 | $31,896.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,586.85 / $24,586.85 / $24,586.85
| Facility | | $24,586.85 | $24,586.85 | $24,586.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,430.27 / $29,962.40 / $51,872.98
| Facility | | $19,430.27 | $29,962.40 | $51,872.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,906.74 / $36,008.91 / $55,192.80
| Facility | | $19,906.74 | $36,008.91 | $55,192.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,901.00 / $47,653.20 / $61,528.26
| Facility | | $26,901.00 | $47,653.20 | $61,528.26 |