- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,904.80 / $15,787.80 / $25,420.40
| Facility | | $6,904.80 | $15,787.80 | $25,420.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $8,754.36 / $23,014.89
| Facility | | $1,474.01 | $8,754.36 | $23,014.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,428.37 / $16,507.20 / $23,384.44
| Facility | | $11,428.37 | $16,507.20 | $23,384.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,989.65 / $13,845.05 / $29,076.31
| Facility | | $9,989.65 | $13,845.05 | $29,076.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,379.24 / $13,845.05 / $29,451.74
| Facility | | $9,379.24 | $13,845.05 | $29,451.74 |