- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,646.70 / $15,823.10 / $23,518.00
| Facility | | $11,646.70 | $15,823.10 | $23,518.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,362.04 / $14,608.89 / $21,207.72
| Facility | | $9,362.04 | $14,608.89 | $21,207.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,160.28 / $14,026.87 / $25,388.00
| Facility | | $10,160.28 | $14,026.87 | $25,388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $148.76 / $237.09
| Facility | | $108.00 | $148.76 | $237.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,191.03 / $15,487.95 / $25,489.55
| Facility | | $11,191.03 | $15,487.95 | $25,489.55 |