- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,441.19 / $13,325.00 / $22,995.50
| Facility | | $6,441.19 | $13,325.00 | $22,995.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,533.52 / $23,050.67 / $29,889.62
| Facility | | $15,533.52 | $23,050.67 | $29,889.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,595.29 / $18,454.16 / $29,506.28
| Facility | | $14,595.29 | $18,454.16 | $29,506.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,346.21 / $19,880.50 / $41,690.06
| Facility | | $10,346.21 | $19,880.50 | $41,690.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,616.72 / $7,646.99 / $8,112.68
| Facility | | $7,616.72 | $7,646.99 | $8,112.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,595.29 / $19,749.23 / $29,513.56
| Facility | | $14,595.29 | $19,749.23 | $29,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,902.00 / $25,383.49
| Facility | | $4,870.00 | $15,902.00 | $25,383.49 |