- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,651.00 / $10,306.00 / $18,390.00
| Facility | | $3,651.00 | $10,306.00 | $18,390.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,773.23 / $17,444.52 / $24,165.40
| Facility | | $11,773.23 | $17,444.52 | $24,165.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,823.41 / $15,261.92 / $21,880.94
| Facility | | $10,823.41 | $15,261.92 | $21,880.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,672.43 / $14,742.77 / $30,916.05
| Facility | | $7,672.43 | $14,742.77 | $30,916.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,823.41 / $16,487.84 / $21,886.34
| Facility | | $10,823.41 | $16,487.84 | $21,886.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,346.00 / $13,911.95 / $19,351.00
| Facility | | $4,346.00 | $13,911.95 | $19,351.00 |