- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,623.41 / $12,302.69
| Facility | | $2,089.30 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $30,902.95 / $45,708.82
| Facility | | $9,549.93 | $30,902.95 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,022.64 / $18,620.87
| Facility | | $8,317.64 | $12,022.64 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,187.76 / $22,387.21
| Facility | | $891.25 | $2,187.76 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $13,182.57 / $23,988.33
| Facility | | $4,570.88 | $13,182.57 | $23,988.33 |