- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,864.20 / $15,865.00 / $20,852.09
| Facility | | $10,864.20 | $15,865.00 | $20,852.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,337.82 / $19,983.65 / $33,799.64
| Facility | | $7,337.82 | $19,983.65 | $33,799.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,036.56 / $15,935.50 / $26,672.43
| Facility | | $11,036.56 | $15,935.50 | $26,672.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,665.72 / $17,784.23 / $25,966.43
| Facility | | $13,665.72 | $17,784.23 | $25,966.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,665.72 / $16,532.81 / $25,966.43
| Facility | | $13,665.72 | $16,532.81 | $25,966.43 |