- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,686.27 / $15,032.00 / $25,748.10
| Facility | | $7,686.27 | $15,032.00 | $25,748.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,725.72 / $24,819.82 / $32,183.67
| Facility | | $16,725.72 | $24,819.82 | $32,183.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,646.00 / $20,663.20 / $33,038.28
| Facility | | $14,646.00 | $20,663.20 | $33,038.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,584.70 / $22,260.28 / $46,680.51
| Facility | | $11,584.70 | $22,260.28 | $46,680.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,342.39 / $22,113.28 / $33,046.44
| Facility | | $16,342.39 | $22,113.28 | $33,046.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,686.85 / $16,763.00 / $28,421.98
| Facility | | $4,686.85 | $16,763.00 | $28,421.98 |