- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,339.10 / $13,695.60 / $23,962.00
| Facility | | $10,339.10 | $13,695.60 | $23,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,892.44 / $10,788.97 / $11,327.62
| Facility | | $9,892.44 | $10,788.97 | $11,327.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,270.48 / $23,963.18
| Facility | | $5,843.91 | $12,270.48 | $23,963.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,917.26 / $14,031.81 / $21,393.90
| Facility | | $9,917.26 | $14,031.81 | $21,393.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,113.92 / $21,557.27
| Facility | | $3,496.00 | $14,113.92 | $21,557.27 |