- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $15,848.93 / $43,651.58
| Facility | | $10,232.93 | $15,848.93 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $19,498.45 / $30,199.52
| Facility | | $13,489.63 | $19,498.45 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $21,379.62 / $28,840.32
| Facility | | $13,803.84 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,095.73 / $63,095.73 / $63,095.73
| Facility | | $63,095.73 | $63,095.73 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $21,877.62 / $33,884.42
| Facility | | $2,951.21 | $21,877.62 | $33,884.42 |