- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,640.62 / $16,160.60 / $26,716.80
| Facility | | $7,640.62 | $16,160.60 | $26,716.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,662.46 / $26,209.87 / $33,986.12
| Facility | | $17,662.46 | $26,209.87 | $33,986.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,647.00 / $21,440.58 / $34,281.23
| Facility | | $14,647.00 | $21,440.58 | $34,281.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,020.53 / $23,097.74 / $48,436.69
| Facility | | $12,020.53 | $23,097.74 | $48,436.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,957.22 / $22,945.21 / $34,289.69
| Facility | | $16,957.22 | $22,945.21 | $34,289.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $16,763.00 / $29,491.26
| Facility | | $4,870.00 | $16,763.00 | $29,491.26 |