- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,980.48 / $12,151.90 / $21,350.70
| Facility | | $5,980.48 | $12,151.90 | $21,350.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,467.11 / $21,468.20 / $27,837.64
| Facility | | $14,467.11 | $21,468.20 | $27,837.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,551.35 / $17,648.00 / $27,395.82
| Facility | | $13,551.35 | $17,648.00 | $27,395.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,606.20 / $18,458.54 / $38,708.15
| Facility | | $9,606.20 | $18,458.54 | $38,708.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,551.35 / $18,336.65 / $27,402.58
| Facility | | $13,551.35 | $18,336.65 | $27,402.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,433.96 / $15,676.12 / $23,567.92
| Facility | | $4,433.96 | $15,676.12 | $23,567.92 |