- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,715.19 / $28,840.32
| Facility | | $6,760.83 | $10,715.19 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,882.50 / $19,952.62
| Facility | | $8,912.51 | $12,882.50 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,454.40 / $19,054.61
| Facility | | $8,912.51 | $14,454.40 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $41,686.94 / $41,686.94
| Facility | | $41,686.94 | $41,686.94 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $14,791.08 / $22,908.68
| Facility | | $2,951.21 | $14,791.08 | $22,908.68 |