- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,912.51 / $15,488.17
| Facility | | $4,570.88 | $8,912.51 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $19,498.45 / $26,915.35
| Facility | | $8,912.51 | $19,498.45 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $15,488.17 / $33,884.42
| Facility | | $2,187.76 | $15,488.17 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $9,332.54 / $12,022.64
| Facility | | $8,912.51 | $9,332.54 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,964.78 / $18,620.87
| Facility | | $7,244.36 | $10,964.78 | $18,620.87 |