- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,580.30 / $11,108.60 / $19,548.00
| Facility | | $6,580.30 | $11,108.60 | $19,548.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,650.17 / $8,291.95 / $13,717.18
| Facility | | $5,650.17 | $8,291.95 | $13,717.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,985.81 / $10,239.45 / $14,740.13
| Facility | | $5,985.81 | $10,239.45 | $14,740.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,184.85 / $23,184.85 / $27,209.39
| Facility | | $23,184.85 | $23,184.85 | $27,209.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $9,681.08 / $13,828.32
| Facility | | $1,787.00 | $9,681.08 | $13,828.32 |