- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,630.27 / $14,454.40
| Facility | | $1,318.26 | $2,630.27 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $27,542.29 / $32,359.37
| Facility | | $15,848.93 | $27,542.29 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $3,235.94
| Facility | | $1,318.26 | $1,905.46 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $15,135.61 / $22,387.21
| Facility | | $6,760.83 | $15,135.61 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |