- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $11,748.98 / $63,095.73
| Facility | | $1,288.25 | $11,748.98 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $32,359.37 / $63,095.73
| Facility | | $13,489.63 | $32,359.37 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $30,902.95 / $61,659.50
| Facility | | $16,982.44 | $30,902.95 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,318.26 / $2,290.87
| Facility | | $912.01 | $1,318.26 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $23,442.29 / $43,651.58
| Facility | | $5,754.40 | $23,442.29 | $43,651.58 |