- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,008.33 / $12,208.50 / $21,450.10
| Facility | | $6,008.33 | $12,208.50 | $21,450.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,529.04 / $21,560.10 / $27,956.81
| Facility | | $14,529.04 | $21,560.10 | $27,956.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,614.45 / $17,648.00 / $27,523.40
| Facility | | $13,614.45 | $17,648.00 | $27,523.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,650.93 / $18,544.50 / $38,888.41
| Facility | | $9,650.93 | $18,544.50 | $38,888.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,614.45 / $18,422.04 / $27,530.19
| Facility | | $13,614.45 | $18,422.04 | $27,530.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,346.00 / $15,749.12 / $23,677.67
| Facility | | $4,346.00 | $15,749.12 | $23,677.67 |