- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,489.53 / $11,227.00 / $19,598.00
| Facility | | $5,489.53 | $11,227.00 | $19,598.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,516.00 / $19,937.41 / $25,852.70
| Facility | | $13,516.00 | $19,937.41 | $25,852.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,438.90 / $17,539.89 / $25,146.86
| Facility | | $12,438.90 | $17,539.89 | $25,146.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,817.61 / $16,943.25 / $35,530.54
| Facility | | $8,817.61 | $16,943.25 | $35,530.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,438.90 / $17,648.00 / $25,153.06
| Facility | | $12,438.90 | $17,648.00 | $25,153.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $14,449.96 / $22,149.93
| Facility | | $4,870.00 | $14,449.96 | $22,149.93 |