- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,140.08 / $14,806.00 / $19,331.30
| Facility | | $7,140.08 | $14,806.00 | $19,331.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $13,346.24 / $36,206.26
| Facility | | $5,840.42 | $13,346.24 | $36,206.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,365.86 / $13,833.13 / $20,902.03
| Facility | | $8,365.86 | $13,833.13 | $20,902.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,644.47 / $19,644.47 / $19,644.47
| Facility | | $19,644.47 | $19,644.47 | $19,644.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,053.57 / $13,935.64 / $21,519.89
| Facility | | $12,053.57 | $13,935.64 | $21,519.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $13,346.24 / $36,206.26
| Facility | | $5,840.42 | $13,346.24 | $36,206.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,515.08 / $28,295.52
| Facility | | $5,840.42 | $10,515.08 | $28,295.52 |