- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,896.20 / $11,641.90 / $20,486.40
| Facility | | $6,896.20 | $11,641.90 | $20,486.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,035.60 / $5,898.49 / $9,752.83
| Facility | | $4,035.60 | $5,898.49 | $9,752.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,273.17 / $10,731.01 / $15,447.74
| Facility | | $6,273.17 | $10,731.01 | $15,447.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,297.85 / $24,297.85 / $28,515.59
| Facility | | $24,297.85 | $24,297.85 | $28,515.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.00 / $10,698.72 / $17,378.71
| Facility | | $3,158.00 | $10,698.72 | $17,378.71 |