- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,484.53 / $12,635.10 / $22,234.20
| Facility | | $7,484.53 | $12,635.10 | $22,234.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,156.89 / $6,188.28 / $10,174.98
| Facility | | $4,156.89 | $6,188.28 | $10,174.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,808.35 / $11,646.50 / $16,466.75
| Facility | | $6,808.35 | $11,646.50 | $16,466.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,977.20 / $23,977.20 / $28,139.28
| Facility | | $23,977.20 | $23,977.20 | $28,139.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $11,011.40 / $15,728.53
| Facility | | $1,787.00 | $11,011.40 | $15,728.53 |