- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,026.90 / $13,550.70 / $23,845.40
| Facility | | $8,026.90 | $13,550.70 | $23,845.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,892.61 / $8,778.09 / $15,785.60
| Facility | | $5,892.61 | $8,778.09 | $15,785.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,092.33 / $12,490.47 / $17,380.25
| Facility | | $7,092.33 | $12,490.47 | $17,380.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,307.50 / $25,307.50 / $29,700.50
| Facility | | $25,307.50 | $25,307.50 | $29,700.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $11,809.35 / $16,868.30
| Facility | | $1,787.00 | $11,809.35 | $16,868.30 |