- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $12,022.64 / $33,113.11
| Facility | | $7,762.47 | $12,022.64 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,125.38 / $21,877.62
| Facility | | $9,772.37 | $14,125.38 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $16,218.10 / $21,877.62
| Facility | | $10,232.93 | $16,218.10 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,863.01 / $47,863.01 / $47,863.01
| Facility | | $47,863.01 | $47,863.01 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $16,595.87 / $25,703.96
| Facility | | $2,951.21 | $16,595.87 | $25,703.96 |