- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,726.65 / $11,636.10 / $20,444.50
| Facility | | $5,726.65 | $11,636.10 | $20,444.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,827.83 / $20,488.84 / $28,382.61
| Facility | | $13,827.83 | $20,488.84 | $28,382.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,976.19 / $17,647.00 / $26,233.07
| Facility | | $12,976.19 | $17,647.00 | $26,233.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,198.49 / $17,675.11 / $37,065.26
| Facility | | $9,198.49 | $17,675.11 | $37,065.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,778.72 / $7,778.72 / $7,778.72
| Facility | | $7,778.72 | $7,778.72 | $7,778.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,976.19 / $17,648.00 / $26,239.54
| Facility | | $12,976.19 | $17,648.00 | $26,239.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,074.12 / $23,106.69
| Facility | | $4,870.00 | $15,074.12 | $23,106.69 |