- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,609.08 / $13,365.00 / $23,594.90
| Facility | | $6,609.08 | $13,365.00 | $23,594.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,802.54 / $23,449.88 / $30,407.27
| Facility | | $15,802.54 | $23,449.88 | $30,407.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,646.00 / $18,935.18 / $30,275.37
| Facility | | $14,646.00 | $18,935.18 | $30,275.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,615.90 / $20,398.71 / $42,776.73
| Facility | | $10,615.90 | $20,398.71 | $42,776.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,742.14 / $7,742.14 / $7,742.14
| Facility | | $7,742.14 | $7,742.14 | $7,742.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,975.72 / $20,264.00 / $30,282.85
| Facility | | $14,975.72 | $20,264.00 | $30,282.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,808.43 / $16,288.07 / $28,072.09
| Facility | | $6,808.43 | $16,288.07 | $28,072.09 |