- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,952.62 / $53,703.18
| Facility | | $12,882.50 | $19,952.62 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $19,952.62 / $31,622.78
| Facility | | $13,803.84 | $19,952.62 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $26,915.35 / $35,481.34
| Facility | | $16,982.44 | $26,915.35 | $35,481.34 |
- 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
- $2,951.21 / $27,542.29 / $42,657.95
| Facility | | $2,951.21 | $27,542.29 | $42,657.95 |