- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,973.75 / $15,149.20 / $26,658.20
| Facility | | $8,973.75 | $15,149.20 | $26,658.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,340.52 / $6,461.63 / $10,624.44
| Facility | | $4,340.52 | $6,461.63 | $10,624.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,258.37 / $15,694.00 / $20,207.84
| Facility | | $9,258.37 | $15,694.00 | $20,207.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,493.00 / $25,493.00 / $29,918.20
| Facility | | $25,493.00 | $25,493.00 | $29,918.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.00 / $13,502.00 / $21,357.88
| Facility | | $3,158.00 | $13,502.00 | $21,357.88 |