- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,302.69 / $33,884.42
| Facility | | $7,943.28 | $12,302.69 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $14,791.08 / $22,908.68
| Facility | | $10,232.93 | $14,791.08 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $16,595.87 / $22,387.21
| Facility | | $10,715.19 | $16,595.87 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,977.88 / $48,977.88 / $48,977.88
| Facility | | $48,977.88 | $48,977.88 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $16,982.44 / $26,302.68
| Facility | | $2,951.21 | $16,982.44 | $26,302.68 |