- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,589.25 / $20,417.38
| Facility | | $8,317.64 | $12,589.25 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $15,135.61 / $19,498.45
| Facility | | $12,589.25 | $15,135.61 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,120.11 / $15,488.17
| Facility | | $4,570.88 | $9,120.11 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $24,547.09
| Facility | | $7,943.28 | $13,182.57 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $31,622.78
| Facility | | $31,622.78 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $11,748.98 / $20,417.38
| Facility | | $4,786.30 | $11,748.98 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $11,481.54 / $26,302.68
| Facility | | $7,762.47 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,715.19 / $23,988.33
| Facility | | $4,168.69 | $10,715.19 | $23,988.33 |