- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $15,848.93 / $26,915.35
| Facility | | $7,762.47 | $15,848.93 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $14,454.40 / $38,904.51
| Facility | | $6,165.95 | $14,454.40 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $15,135.61 / $22,908.68
| Facility | | $9,120.11 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $22,387.21 / $22,387.21
| Facility | | $22,387.21 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $14,454.40 / $38,904.51
| Facility | | $6,165.95 | $14,454.40 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $14,454.40 / $38,904.51
| Facility | | $6,165.95 | $14,454.40 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $11,748.98 / $33,884.42
| Facility | | $6,165.95 | $11,748.98 | $33,884.42 |