- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,488.60 / $15,295.90 / $24,830.00
| Facility | | $10,488.60 | $15,295.90 | $24,830.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,210.59 / $31,575.67 / $40,481.62
| Facility | | $22,210.59 | $31,575.67 | $40,481.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,316.08 / $24,016.80 / $34,886.83
| Facility | | $12,316.08 | $24,016.80 | $34,886.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,943.10 / $16,449.59 / $26,303.70
| Facility | | $10,943.10 | $16,449.59 | $26,303.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,588.98 / $21,884.46 / $33,248.86
| Facility | | $13,588.98 | $21,884.46 | $33,248.86 |