- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $11,481.54 / $22,387.21
| Facility | | $3,162.28 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $18,620.87 / $23,442.29
| Facility | | $12,589.25 | $18,620.87 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,848.93 / $19,054.61
| Facility | | $10,715.19 | $15,848.93 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $14,125.38 / $35,481.34
| Facility | | $7,943.28 | $14,125.38 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,589.25 / $19,498.45
| Facility | | $4,677.35 | $12,589.25 | $19,498.45 |