- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,030.70 / $18,015.00
| Facility | | $6,303.00 | $11,030.70 | $18,015.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,568.98 / $20,037.34 / $26,885.79
| Facility | | $14,568.98 | $20,037.34 | $26,885.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,936.73 / $16,392.30 / $22,979.31
| Facility | | $11,936.73 | $16,392.30 | $22,979.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,392.00 / $18,205.49 / $22,951.17
| Facility | | $10,392.00 | $18,205.49 | $22,951.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,392.00 / $18,357.04 / $24,071.55
| Facility | | $10,392.00 | $18,357.04 | $24,071.55 |