- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,143.56 / $12,059.50 / $21,221.30
| Facility | | $7,143.56 | $12,059.50 | $21,221.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,300.43 / $6,311.15 / $10,440.37
| Facility | | $4,300.43 | $6,311.15 | $10,440.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,498.19 / $11,115.93 / $15,893.36
| Facility | | $6,498.19 | $11,115.93 | $15,893.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,044.40 / $23,044.40 / $27,044.56
| Facility | | $23,044.40 | $23,044.40 | $27,044.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $10,509.77 / $15,012.00
| Facility | | $1,787.00 | $10,509.77 | $15,012.00 |