- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,025.60 / $23,988.33
| Facility | | $5,623.41 | $6,025.60 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $11,748.98 / $18,620.87
| Facility | | $8,128.31 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,481.54 / $15,848.93
| Facility | | $7,244.36 | $11,481.54 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $32,359.37 / $32,359.37
| Facility | | $23,988.33 | $32,359.37 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,128.31 / $16,218.10
| Facility | | $3,162.28 | $8,128.31 | $16,218.10 |