- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,437.26 / $11,669.00 / $20,498.50
| Facility | | $5,437.26 | $11,669.00 | $20,498.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,205.83 / $21,439.91 / $27,463.21
| Facility | | $14,205.83 | $21,439.91 | $27,463.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,533.36 / $18,849.00 / $26,308.81
| Facility | | $12,533.36 | $18,849.00 | $26,308.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,222.77 / $17,721.77 / $37,163.12
| Facility | | $9,222.77 | $17,721.77 | $37,163.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,533.36 / $19,513.00 / $26,453.86
| Facility | | $12,533.36 | $19,513.00 | $26,453.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,346.00 / $15,113.91 / $23,167.69
| Facility | | $4,346.00 | $15,113.91 | $23,167.69 |