- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $11,748.98 / $24,547.09
| Facility | | $4,786.30 | $11,748.98 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $20,892.96 / $25,703.96
| Facility | | $13,803.84 | $20,892.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,595.87 / $20,892.96
| Facility | | $11,748.98 | $16,595.87 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $15,488.17 / $38,904.51
| Facility | | $8,709.64 | $15,488.17 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $14,125.38 / $20,892.96
| Facility | | $4,897.79 | $14,125.38 | $20,892.96 |