- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,348.60 / $16,960.00 / $25,981.00
| Facility | | $12,348.60 | $16,960.00 | $25,981.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.75 / $15,314.78 / $22,377.25
| Facility | | $9,823.75 | $15,314.78 | $22,377.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,375.54 / $14,347.29 / $26,716.12
| Facility | | $10,375.54 | $14,347.29 | $26,716.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.51 / $157.72 / $251.37
| Facility | | $114.51 | $157.72 | $251.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,865.45 / $16,421.33 / $27,025.67
| Facility | | $11,865.45 | $16,421.33 | $27,025.67 |