- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.57 / $16,327.00 / $21,317.10
| Facility | | $7,873.57 | $16,327.00 | $21,317.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,717.29 / $39,925.69
| Facility | | $5,840.42 | $14,717.29 | $39,925.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,225.28 / $15,254.20 / $23,049.27
| Facility | | $9,225.28 | $15,254.20 | $23,049.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,662.53 / $21,662.53 / $21,662.53
| Facility | | $21,662.53 | $21,662.53 | $21,662.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,291.82 / $15,367.23 / $23,730.61
| Facility | | $13,291.82 | $15,367.23 | $23,730.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,717.29 / $39,925.69
| Facility | | $5,840.42 | $14,717.29 | $39,925.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $14,717.29 / $34,749.21
| Facility | | $3,775.00 | $14,717.29 | $34,749.21 |