- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,772.37 / $26,302.68
| Facility | | $6,309.57 | $9,772.37 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $13,489.63 / $20,892.96
| Facility | | $9,332.54 | $13,489.63 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $15,488.17 / $17,782.79
| Facility | | $9,332.54 | $15,488.17 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,018.94 / $38,018.94 / $38,018.94
| Facility | | $38,018.94 | $38,018.94 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $13,489.63 / $20,892.96
| Facility | | $2,951.21 | $13,489.63 | $20,892.96 |