- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,756.00 / $10,527.70 / $18,563.00
| Facility | | $4,756.00 | $10,527.70 | $18,563.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,322.69 / $18,286.02 / $23,711.34
| Facility | | $12,322.69 | $18,286.02 | $23,711.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,366.11 / $16,027.18 / $22,978.08
| Facility | | $11,366.11 | $16,027.18 | $22,978.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,057.14 / $15,481.99 / $32,466.23
| Facility | | $8,057.14 | $15,481.99 | $32,466.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,366.11 / $17,314.57 / $22,983.75
| Facility | | $11,366.11 | $17,314.57 | $22,983.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,550.85 / $13,968.00 / $20,239.62
| Facility | | $4,550.85 | $13,968.00 | $20,239.62 |