- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $15,848.93 / $42,657.95
| Facility | | $10,232.93 | $15,848.93 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,125.38 / $22,387.21
| Facility | | $9,772.37 | $14,125.38 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $21,379.62 / $28,840.32
| Facility | | $13,182.57 | $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 |