- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,244.51 / $15,606.30 / $27,462.50
| Facility | | $9,244.51 | $15,606.30 | $27,462.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,161.58 / $7,619.00 / $12,634.19
| Facility | | $5,161.58 | $7,619.00 | $12,634.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,409.33 / $14,385.17 / $19,866.08
| Facility | | $8,409.33 | $14,385.17 | $19,866.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,236.70 / $27,236.70 / $31,964.58
| Facility | | $27,236.70 | $27,236.70 | $31,964.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $13,600.73 / $19,427.08
| Facility | | $1,787.00 | $13,600.73 | $19,427.08 |