- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,165.95 / $16,982.44
| Facility | | $3,981.07 | $6,165.95 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,762.47 / $12,022.64
| Facility | | $5,370.32 | $7,762.47 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,317.64 / $11,220.18
| Facility | | $5,370.32 | $8,317.64 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $52,480.75 / $52,480.75
| Facility | | $24,547.09 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,709.64 / $13,182.57
| Facility | | $2,951.21 | $8,709.64 | $13,182.57 |