- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,356.65 / $11,227.00 / $19,123.59
| Facility | | $5,356.65 | $11,227.00 | $19,123.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,033.12 / $19,311.32 / $26,751.43
| Facility | | $13,033.12 | $19,311.32 | $26,751.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,137.80 / $17,115.32 / $24,538.14
| Facility | | $12,137.80 | $17,115.32 | $24,538.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,604.17 / $16,533.12 / $34,670.47
| Facility | | $8,604.17 | $16,533.12 | $34,670.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,137.80 / $17,648.00 / $24,544.20
| Facility | | $12,137.80 | $17,648.00 | $24,544.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,362.63 / $14,238.00 / $21,613.76
| Facility | | $4,362.63 | $14,238.00 | $21,613.76 |