- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.00 / $11,913.80 / $21,769.10
| Facility | | $1,973.00 | $11,913.80 | $21,769.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,658.59 / $9,963.71 / $16,852.29
| Facility | | $3,658.59 | $9,963.71 | $16,852.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,688.02 / $20,540.72 / $32,648.89
| Facility | | $12,688.02 | $20,540.72 | $32,648.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,985.95 / $19,502.36 / $28,475.03
| Facility | | $14,985.95 | $19,502.36 | $28,475.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,398.09 / $18,766.80 / $27,051.17
| Facility | | $12,398.09 | $18,766.80 | $27,051.17 |