- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,815.00 / $10,554.40 / $18,563.00
| Facility | | $4,815.00 | $10,554.40 | $18,563.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,922.26 / $18,937.96 / $24,556.71
| Facility | | $12,922.26 | $18,937.96 | $24,556.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,394.96 / $16,067.85 / $23,036.40
| Facility | | $11,394.96 | $16,067.85 | $23,036.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,077.59 / $15,521.29 / $32,548.63
| Facility | | $8,077.59 | $15,521.29 | $32,548.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,394.96 / $17,358.50 / $23,042.09
| Facility | | $11,394.96 | $17,358.50 | $23,042.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,562.41 / $13,968.00 / $20,290.99
| Facility | | $4,562.41 | $13,968.00 | $20,290.99 |