- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,842.22 / $14,982.00 / $25,295.70
| Facility | | $6,842.22 | $14,982.00 | $25,295.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,802.54 / $21,140.81 / $30,407.27
| Facility | | $15,802.54 | $21,140.81 | $30,407.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,935.47 / $21,357.15 / $31,351.09
| Facility | | $14,935.47 | $21,357.15 | $31,351.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,990.38 / $21,118.28 / $44,285.71
| Facility | | $10,990.38 | $21,118.28 | $44,285.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,935.47 / $22,709.00 / $31,523.93
| Facility | | $14,935.47 | $22,709.00 | $31,523.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $19,928.18 / $29,878.09
| Facility | | $4,870.00 | $19,928.18 | $29,878.09 |