- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,803.84 / $37,153.52
| Facility | | $8,709.64 | $13,803.84 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $13,803.84 / $21,379.62
| Facility | | $9,549.93 | $13,803.84 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $18,620.87 / $24,547.09
| Facility | | $11,748.98 | $18,620.87 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,703.18 / $53,703.18 / $53,703.18
| Facility | | $53,703.18 | $53,703.18 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $19,054.61 / $29,512.09
| Facility | | $2,951.21 | $19,054.61 | $29,512.09 |