- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,691.60 / $20,113.40 / $33,393.00
| Facility | | $12,691.60 | $20,113.40 | $33,393.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,424.97 / $17,051.73 / $28,993.65
| Facility | | $11,424.97 | $17,051.73 | $28,993.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,492.16 / $21,453.26 / $30,718.46
| Facility | | $16,492.16 | $21,453.26 | $30,718.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,365.37 / $20,608.30 / $51,087.97
| Facility | | $10,365.37 | $20,608.30 | $51,087.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,365.37 / $20,563.47 / $28,900.94
| Facility | | $10,365.37 | $20,563.47 | $28,900.94 |