- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,873.86 / $11,935.20 / $20,970.00
| Facility | | $5,873.86 | $11,935.20 | $20,970.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,774.24 / $20,440.02 / $27,538.51
| Facility | | $13,774.24 | $20,440.02 | $27,538.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,309.75 / $17,648.00 / $26,907.39
| Facility | | $13,309.75 | $17,648.00 | $26,907.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,434.93 / $18,129.45 / $38,018.04
| Facility | | $9,434.93 | $18,129.45 | $38,018.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,189.93 / $7,189.93 / $7,482.00
| Facility | | $7,189.93 | $7,189.93 | $7,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,309.75 / $18,009.73 / $26,914.03
| Facility | | $13,309.75 | $18,009.73 | $26,914.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.14 / $15,422.00 / $23,415.00
| Facility | | $4,472.14 | $15,422.00 | $23,415.00 |