- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,976.00 / $16,990.59 / $19,227.59
| Facility | | $10,976.00 | $16,990.59 | $19,227.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,988.84 / $16,620.30 / $22,446.97
| Facility | | $10,988.84 | $16,620.30 | $22,446.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,135.53 / $14,905.66 / $21,313.55
| Facility | | $10,135.53 | $14,905.66 | $21,313.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,938.00 / $16,591.00 / $20,738.00
| Facility | | $10,938.00 | $16,591.00 | $20,738.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $15,853.02 / $26,071.91
| Facility | | $5,274.00 | $15,853.02 | $26,071.91 |