- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,351.60 / $12,368.20 / $20,898.70
| Facility | | $7,351.60 | $12,368.20 | $20,898.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,640.00 / $11,453.02 / $14,100.80
| Facility | | $9,640.00 | $11,453.02 | $14,100.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,736.54 / $11,286.80 / $27,568.03
| Facility | | $7,736.54 | $11,286.80 | $27,568.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,815.91 / $7,725.44 / $16,254.08
| Facility | | $3,815.91 | $7,725.44 | $16,254.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,428.00 / $10,819.19 / $14,693.32
| Facility | | $5,428.00 | $10,819.19 | $14,693.32 |