- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $36,307.81 / $48,977.88
| Facility | | $24,547.09 | $36,307.81 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,234.13 / $56,234.13 / $56,234.13
| Facility | | $56,234.13 | $56,234.13 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $37,153.52 / $48,977.88
| Facility | | $17,782.79 | $37,153.52 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $33,113.11 / $48,977.88
| Facility | | $21,379.62 | $33,113.11 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $16,982.44 / $42,657.95
| Facility | | $6,165.95 | $16,982.44 | $42,657.95 |