- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,342.52 / $13,269.00 / $22,643.20
| Facility | | $6,342.52 | $13,269.00 | $22,643.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,496.74 / $22,996.10 / $29,818.86
| Facility | | $15,496.74 | $22,996.10 | $29,818.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,371.71 / $18,171.49 / $29,054.30
| Facility | | $14,371.71 | $18,171.49 | $29,054.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,187.74 / $19,575.98 / $41,051.44
| Facility | | $10,187.74 | $19,575.98 | $41,051.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,371.71 / $19,446.71 / $29,061.47
| Facility | | $14,371.71 | $19,446.71 | $29,061.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,845.55 / $24,994.66
| Facility | | $4,870.00 | $15,845.55 | $24,994.66 |