- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,549.93 / $30,199.52
| Facility | | $4,570.88 | $9,549.93 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $21,877.62 / $26,915.35
| Facility | | $8,912.51 | $21,877.62 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $22,908.68
| Facility | | $851.14 | $851.14 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $23,988.33 / $25,703.96
| Facility | | $22,908.68 | $23,988.33 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,454.40 / $23,442.29
| Facility | | $8,912.51 | $14,454.40 | $23,442.29 |