- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,243.85 / $12,228.80 / $21,519.20
| Facility | | $7,243.85 | $12,228.80 | $21,519.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,631.13 / $8,382.94 / $13,743.60
| Facility | | $5,631.13 | $8,382.94 | $13,743.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,589.41 / $11,271.98 / $16,062.01
| Facility | | $6,589.41 | $11,271.98 | $16,062.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,490.55 / $22,490.55 / $26,394.57
| Facility | | $22,490.55 | $22,490.55 | $26,394.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $10,657.31 / $15,222.74
| Facility | | $1,787.00 | $10,657.31 | $15,222.74 |