- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,893.60 / $16,158.40 / $25,395.00
| Facility | | $11,893.60 | $16,158.40 | $25,395.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,678.52 / $14,917.24 / $21,626.35
| Facility | | $9,678.52 | $14,917.24 | $21,626.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,375.59 / $14,324.12 / $25,926.00
| Facility | | $10,375.59 | $14,324.12 | $25,926.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.29 / $151.91 / $242.11
| Facility | | $110.29 | $151.91 | $242.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,428.18 / $15,816.16 / $26,029.70
| Facility | | $11,428.18 | $15,816.16 | $26,029.70 |