- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,511.38 / $14,125.38
| Facility | | $4,365.16 | $8,511.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $31,622.78
| Facility | | $8,912.51 | $17,378.01 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $26,302.68
| Facility | | $851.14 | $851.14 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $9,332.54 / $16,982.44
| Facility | | $8,912.51 | $9,332.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $21,877.62
| Facility | | $8,912.51 | $12,589.25 | $21,877.62 |