- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,718.19 / $11,341.40 / $19,957.59
| Facility | | $6,718.19 | $11,341.40 | $19,957.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,371.45 / $21,765.32 / $35,471.19
| Facility | | $15,371.45 | $21,765.32 | $35,471.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,111.25 / $10,454.02 / $15,049.01
| Facility | | $6,111.25 | $10,454.02 | $15,049.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,666.40 / $21,666.40 / $25,427.36
| Facility | | $21,666.40 | $21,666.40 | $25,427.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.00 / $10,108.00 / $16,532.20
| Facility | | $3,158.00 | $10,108.00 | $16,532.20 |