- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,919.41 / $14,772.80 / $24,702.70
| Facility | | $6,919.41 | $14,772.80 | $24,702.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,124.41 / $25,411.45 / $32,950.83
| Facility | | $17,124.41 | $25,411.45 | $32,950.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,646.00 / $19,824.27 / $31,696.92
| Facility | | $14,646.00 | $19,824.27 | $31,696.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,114.36 / $21,356.51 / $44,785.27
| Facility | | $11,114.36 | $21,356.51 | $44,785.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,678.89 / $21,215.47 / $31,704.75
| Facility | | $15,678.89 | $21,215.47 | $31,704.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $16,763.00 / $27,268.05
| Facility | | $4,870.00 | $16,763.00 | $27,268.05 |