- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,331.19 / $11,189.00 / $19,307.40
| Facility | | $5,331.19 | $11,189.00 | $19,307.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,502.19 / $20,006.34 / $27,714.23
| Facility | | $13,502.19 | $20,006.34 | $27,714.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,080.10 / $17,033.96 / $24,421.50
| Facility | | $12,080.10 | $17,033.96 | $24,421.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,563.27 / $16,454.53 / $34,505.67
| Facility | | $8,563.27 | $16,454.53 | $34,505.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,080.10 / $17,648.00 / $24,427.53
| Facility | | $12,080.10 | $17,648.00 | $24,427.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,504.57 / $14,238.00 / $21,511.02
| Facility | | $4,504.57 | $14,238.00 | $21,511.02 |