- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,202.00 / $9,312.08 / $16,327.60
| Facility | | $5,202.00 | $9,312.08 | $16,327.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,309.78 / $11,309.78 / $11,882.11
| Facility | | $11,309.78 | $11,309.78 | $11,882.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,138.14 / $8,111.69 / $11,423.95
| Facility | | $4,138.14 | $8,111.69 | $11,423.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,073.22 / $8,988.00 / $14,255.92
| Facility | | $6,073.22 | $8,988.00 | $14,255.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,897.60 / $10,700.43 / $17,871.41
| Facility | | $5,897.60 | $10,700.43 | $17,871.41 |