- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,859.76 / $13,268.60 / $23,348.90
| Facility | | $7,859.76 | $13,268.60 | $23,348.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,465.20 / $16,928.59 / $27,834.60
| Facility | | $11,465.20 | $16,928.59 | $27,834.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,149.68 / $12,230.38 / $17,097.79
| Facility | | $7,149.68 | $12,230.38 | $17,097.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,498.76 / $24,183.90 / $28,381.86
| Facility | | $11,498.76 | $24,183.90 | $28,381.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $12,193.58 / $16,517.06
| Facility | | $1,787.00 | $12,193.58 | $16,517.06 |