- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,881.60 / $16,142.20 / $25,417.00
| Facility | | $11,881.60 | $16,142.20 | $25,417.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,671.06 / $14,905.73 / $21,609.66
| Facility | | $9,671.06 | $14,905.73 | $21,609.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,365.18 / $14,309.75 / $25,900.00
| Facility | | $10,365.18 | $14,309.75 | $25,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.18 / $151.76 / $241.87
| Facility | | $110.18 | $151.76 | $241.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,416.72 / $15,800.30 / $26,003.60
| Facility | | $11,416.72 | $15,800.30 | $26,003.60 |