- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,609.65 / $18,236.70 / $30,277.20
| Facility | | $12,609.65 | $18,236.70 | $30,277.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49,651.57 / $49,651.57 / $49,651.57
| Facility | | $49,651.57 | $49,651.57 | $49,651.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,310.91 / $16,944.41 / $28,704.19
| Facility | | $11,310.91 | $16,944.41 | $28,704.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,719.43 / $19,451.50 / $27,968.89
| Facility | | $15,719.43 | $19,451.50 | $27,968.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,398.20 / $19,528.12 / $50,577.93
| Facility | | $9,398.20 | $19,528.12 | $50,577.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,398.20 / $18,644.74 / $26,204.26
| Facility | | $9,398.20 | $18,644.74 | $26,204.26 |