- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,952.62 / $54,954.09
| Facility | | $12,882.50 | $19,952.62 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $24,547.09 / $38,904.51
| Facility | | $16,982.44 | $24,547.09 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $26,915.35 / $36,307.81
| Facility | | $17,378.01 | $26,915.35 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79,432.82 / $79,432.82 / $79,432.82
| Facility | | $79,432.82 | $79,432.82 | $79,432.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $24,547.09 / $40,738.03
| Facility | | $3,801.89 | $24,547.09 | $40,738.03 |