- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,982.60 / $14,548.00 / $25,453.40
| Facility | | $10,982.60 | $14,548.00 | $25,453.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,357.06 / $11,792.23 / $19,055.66
| Facility | | $10,357.06 | $11,792.23 | $19,055.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,449.35 / $25,088.62
| Facility | | $5,843.91 | $12,449.35 | $25,088.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,421.57 / $14,775.67 / $22,725.45
| Facility | | $10,421.57 | $14,775.67 | $22,725.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,992.37 / $22,898.99
| Facility | | $3,496.00 | $14,992.37 | $22,898.99 |