- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,017.08 / $12,226.20 / $21,481.40
| Facility | | $6,017.08 | $12,226.20 | $21,481.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,259.05 / $21,520.23 / $27,566.09
| Facility | | $14,259.05 | $21,520.23 | $27,566.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,634.29 / $17,648.00 / $27,563.49
| Facility | | $13,634.29 | $17,648.00 | $27,563.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,664.99 / $18,571.52 / $38,945.06
| Facility | | $9,664.99 | $18,571.52 | $38,945.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,634.29 / $18,448.88 / $27,570.30
| Facility | | $13,634.29 | $18,448.88 | $27,570.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,772.06 / $23,712.16
| Facility | | $4,870.00 | $15,772.06 | $23,712.16 |