- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $30,199.52 / $42,657.95
| Facility | | $19,952.62 | $30,199.52 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $25,118.86 / $42,657.95
| Facility | | $9,332.54 | $25,118.86 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $25,118.86 / $44,668.36
| Facility | | $17,782.79 | $25,118.86 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $27,542.29 / $39,810.72
| Facility | | $21,877.62 | $27,542.29 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $26,302.68 / $38,904.51
| Facility | | $13,803.84 | $26,302.68 | $38,904.51 |