- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,477.60 / $11,227.00 / $19,555.40
| Facility | | $5,477.60 | $11,227.00 | $19,555.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,309.74 / $19,750.74 / $26,609.86
| Facility | | $13,309.74 | $19,750.74 | $26,609.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,411.85 / $17,501.75 / $25,092.18
| Facility | | $12,411.85 | $17,501.75 | $25,092.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,798.44 / $16,906.41 / $35,453.29
| Facility | | $8,798.44 | $16,906.41 | $35,453.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,411.85 / $17,648.00 / $25,098.38
| Facility | | $12,411.85 | $17,648.00 | $25,098.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $14,418.54 / $22,101.77
| Facility | | $4,870.00 | $14,418.54 | $22,101.77 |