- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $12,882.50 / $34,673.69
| Facility | | $8,128.31 | $12,882.50 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,964.78 / $17,378.01
| Facility | | $7,585.78 | $10,964.78 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $17,378.01 / $22,908.68
| Facility | | $10,964.78 | $17,378.01 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $50,118.72 / $50,118.72
| Facility | | $50,118.72 | $50,118.72 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $17,782.79 / $27,542.29
| Facility | | $2,951.21 | $17,782.79 | $27,542.29 |