- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $14,125.38 / $19,054.61
| Facility | | $5,495.41 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $15,488.17
| Facility | | $15,488.17 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,471.29 / $12,022.64
| Facility | | $7,762.47 | $10,471.29 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $14,791.08 / $20,892.96
| Facility | | $12,022.64 | $14,791.08 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $16,218.10 / $21,379.62
| Facility | | $2,041.74 | $16,218.10 | $21,379.62 |