- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,435.28 / $9,457.60 / $14,823.80
| Facility | | $6,435.28 | $9,457.60 | $14,823.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,282.46 / $23,147.95 / $29,676.86
| Facility | | $16,282.46 | $23,147.95 | $29,676.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,242.68 / $14,003.05 / $17,711.32
| Facility | | $7,242.68 | $14,003.05 | $17,711.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,435.28 / $9,673.48 / $15,468.30
| Facility | | $6,435.28 | $9,673.48 | $15,468.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,525.99 / $12,869.53 / $19,552.56
| Facility | | $7,525.99 | $12,869.53 | $19,552.56 |