- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,635.84 / $15,834.00 / $20,673.50
| Facility | | $7,635.84 | $15,834.00 | $20,673.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,272.93 / $38,720.22
| Facility | | $5,840.42 | $14,272.93 | $38,720.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,946.74 / $14,793.63 / $22,353.35
| Facility | | $8,946.74 | $14,793.63 | $22,353.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,008.47 / $21,008.47 / $21,008.47
| Facility | | $21,008.47 | $21,008.47 | $21,008.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,890.50 / $14,903.25 / $23,014.11
| Facility | | $12,890.50 | $14,903.25 | $23,014.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,272.93 / $38,720.22
| Facility | | $5,840.42 | $14,272.93 | $38,720.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $14,272.93 / $33,700.03
| Facility | | $3,775.00 | $14,272.93 | $33,700.03 |