- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,255.10 / $14,975.50 / $19,683.00
| Facility | | $10,255.10 | $14,975.50 | $19,683.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,366.87 / $14,616.01 / $24,721.01
| Facility | | $5,366.87 | $14,616.01 | $24,721.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,417.79 / $15,042.06 / $26,954.44
| Facility | | $10,417.79 | $15,042.06 | $26,954.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,899.53 / $16,787.14 / $24,510.59
| Facility | | $12,899.53 | $16,787.14 | $24,510.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,899.53 / $15,605.88 / $24,510.59
| Facility | | $12,899.53 | $15,605.88 | $24,510.59 |