- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,947.00 / $15,648.10 / $25,235.70
| Facility | | $1,947.00 | $15,648.10 | $25,235.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,788.00 / $20,292.38 / $24,651.02
| Facility | | $9,788.00 | $20,292.38 | $24,651.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,990.06 / $17,440.77 / $27,695.11
| Facility | | $10,990.06 | $17,440.77 | $27,695.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,987.49 / $17,291.29 / $32,020.32
| Facility | | $9,987.49 | $17,291.29 | $32,020.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,021.00 / $14,912.00 / $25,785.87
| Facility | | $8,021.00 | $14,912.00 | $25,785.87 |