- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $19,498.45 / $53,703.18
| Facility | | $12,589.25 | $19,498.45 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $20,892.96 / $33,113.11
| Facility | | $14,454.40 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $26,302.68 / $34,673.69
| Facility | | $16,218.10 | $26,302.68 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77,624.71 / $77,624.71 / $77,624.71
| Facility | | $77,624.71 | $77,624.71 | $77,624.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $26,915.35 / $41,686.94
| Facility | | $2,951.21 | $26,915.35 | $41,686.94 |