- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,699.21 / $13,031.30 / $20,982.00
| Facility | | $5,699.21 | $13,031.30 | $20,982.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,716.10 / $12,716.10 / $12,716.10
| Facility | | $12,716.10 | $12,716.10 | $12,716.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $6,764.04 / $18,207.61
| Facility | | $1,474.01 | $6,764.04 | $18,207.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,432.95 / $13,625.01 / $19,301.47
| Facility | | $9,432.95 | $13,625.01 | $19,301.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,245.44 / $11,427.67 / $23,999.53
| Facility | | $8,245.44 | $11,427.67 | $23,999.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,741.61 / $11,427.67 / $24,309.41
| Facility | | $7,741.61 | $11,427.67 | $24,309.41 |