- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,267.25 / $12,268.30 / $21,588.70
| Facility | | $7,267.25 | $12,268.30 | $21,588.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,301.90 / $4,675.34 / $7,619.46
| Facility | | $3,301.90 | $4,675.34 | $7,619.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,610.70 / $11,308.39 / $16,101.36
| Facility | | $6,610.70 | $11,308.39 | $16,101.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,447.20 / $23,447.20 / $27,517.28
| Facility | | $23,447.20 | $23,447.20 | $27,517.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $10,691.73 / $15,271.92
| Facility | | $1,787.00 | $10,691.73 | $15,271.92 |