- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,715.19 / $29,512.09
| Facility | | $6,918.31 | $10,715.19 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,709.64 / $13,489.63
| Facility | | $6,025.60 | $8,709.64 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,454.40 / $19,498.45
| Facility | | $8,912.51 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,657.95 / $42,657.95 / $42,657.95
| Facility | | $42,657.95 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $15,135.61 / $22,908.68
| Facility | | $2,951.21 | $15,135.61 | $22,908.68 |