- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,425.20 / $11,572.60 / $20,453.00
| Facility | | $5,425.20 | $11,572.60 | $20,453.00 |
- 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
- $12,981.60 / $17,647.00 / $26,244.00
| Facility | | $12,981.60 | $17,647.00 | $26,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,202.32 / $17,682.48 / $37,080.72
| Facility | | $9,202.32 | $17,682.48 | $37,080.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,981.60 / $17,648.00 / $26,250.48
| Facility | | $12,981.60 | $17,648.00 | $26,250.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,346.00 / $15,080.40 / $23,116.32
| Facility | | $4,346.00 | $15,080.40 | $23,116.32 |