- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $39,810.72 / $75,857.76
| Facility | | $21,877.62 | $39,810.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $39,810.72 / $39,810.72
| Facility | | $39,810.72 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $53,703.18 / $67,608.30
| Facility | | $33,884.42 | $53,703.18 | $67,608.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $51,286.14 / $107,151.93
| Facility | | $13,182.57 | $51,286.14 | $107,151.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $52,480.75 / $70,794.58
| Facility | | $28,183.83 | $52,480.75 | $70,794.58 |