- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,673.90 / $11,266.60 / $19,826.00
| Facility | | $6,673.90 | $11,266.60 | $19,826.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,823.22 / $6,972.30 / $11,362.85
| Facility | | $4,823.22 | $6,972.30 | $11,362.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,070.96 / $10,385.10 / $14,949.79
| Facility | | $6,070.96 | $10,385.10 | $14,949.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,284.80 / $21,284.80 / $24,979.52
| Facility | | $21,284.80 | $21,284.80 | $24,979.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $9,619.94 / $14,025.01
| Facility | | $1,787.00 | $9,619.94 | $14,025.01 |