- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,978.80 / $14,915.60 / $21,065.00
| Facility | | $10,978.80 | $14,915.60 | $21,065.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,766.42 / $13,822.16 / $19,974.78
| Facility | | $8,766.42 | $13,822.16 | $19,974.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,577.59 / $13,222.43 / $23,932.00
| Facility | | $9,577.59 | $13,222.43 | $23,932.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.80 / $140.22 / $223.49
| Facility | | $101.80 | $140.22 | $223.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,549.23 / $14,599.72 / $24,027.73
| Facility | | $10,549.23 | $14,599.72 | $24,027.73 |