- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,706.76 / $11,595.70 / $20,373.50
| Facility | | $5,706.76 | $11,595.70 | $20,373.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,209.70 / $21,086.22 / $27,342.34
| Facility | | $14,209.70 | $21,086.22 | $27,342.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,931.12 / $17,646.00 / $26,141.94
| Facility | | $12,931.12 | $17,646.00 | $26,141.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,166.53 / $17,613.71 / $36,936.51
| Facility | | $9,166.53 | $17,613.71 | $36,936.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,931.12 / $17,648.00 / $26,148.39
| Facility | | $12,931.12 | $17,648.00 | $26,148.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,021.75 / $23,026.42
| Facility | | $4,870.00 | $15,021.75 | $23,026.42 |