- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,714.60 / $14,556.60 / $20,838.00
| Facility | | $10,714.60 | $14,556.60 | $20,838.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,480.52 / $13,487.29 / $19,624.73
| Facility | | $8,480.52 | $13,487.29 | $19,624.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,347.07 / $12,904.19 / $23,356.00
| Facility | | $9,347.07 | $12,904.19 | $23,356.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.35 / $136.85 / $218.11
| Facility | | $99.35 | $136.85 | $218.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,295.32 / $14,248.33 / $23,449.42
| Facility | | $10,295.32 | $14,248.33 | $23,449.42 |