- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,853.96 / $11,894.80 / $20,899.00
| Facility | | $5,853.96 | $11,894.80 | $20,899.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,308.41 / $21,232.69 / $27,532.27
| Facility | | $14,308.41 | $21,232.69 | $27,532.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,264.67 / $17,648.00 / $26,816.27
| Facility | | $13,264.67 | $17,648.00 | $26,816.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,402.98 / $18,068.06 / $37,889.29
| Facility | | $9,402.98 | $18,068.06 | $37,889.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,767.70 / $7,045.51 / $7,786.36
| Facility | | $6,767.70 | $7,045.51 | $7,786.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,264.67 / $17,948.74 / $26,822.89
| Facility | | $13,264.67 | $17,948.74 | $26,822.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,409.24 / $23,415.00
| Facility | | $4,870.00 | $15,409.24 | $23,415.00 |