- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,762.30 / $15,980.10 / $24,365.00
| Facility | | $11,762.30 | $15,980.10 | $24,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,573.96 / $14,756.10 / $21,392.73
| Facility | | $9,573.96 | $14,756.10 | $21,392.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,204.71 / $13,677.66 / $25,640.00
| Facility | | $10,204.71 | $13,677.66 | $25,640.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.07 / $150.24 / $239.44
| Facility | | $109.07 | $150.24 | $239.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,302.11 / $15,641.68 / $25,742.56
| Facility | | $11,302.11 | $15,641.68 | $25,742.56 |