- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,413.10 / $15,488.17
| Facility | | $4,570.88 | $7,413.10 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $26,915.35
| Facility | | $8,912.51 | $17,378.01 | $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 / $8,912.51 / $9,120.11
| Facility | | $8,912.51 | $8,912.51 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $15,488.17
| Facility | | $4,570.88 | $7,079.46 | $15,488.17 |