- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,466.84 / $30,902.95
| Facility | | $1,348.96 | $4,466.84 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,964.78 / $17,378.01
| Facility | | $5,754.40 | $10,964.78 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $14,791.08 / $23,442.29
| Facility | | $9,332.54 | $14,791.08 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $14,125.38 / $25,118.86
| Facility | | $8,128.31 | $14,125.38 | $25,118.86 |