- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $18,620.87 / $27,542.29
| Facility | | $7,943.28 | $18,620.87 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $19,952.62
| Facility | | $10,715.19 | $10,715.19 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $20,417.38 / $23,442.29
| Facility | | $15,135.61 | $20,417.38 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $21,379.62 / $30,199.52
| Facility | | $17,378.01 | $21,379.62 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,309.57 / $26,302.68
| Facility | | $1,819.70 | $6,309.57 | $26,302.68 |