- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,806.50 / $17,398.59 / $25,487.00
| Facility | | $12,806.50 | $17,398.59 | $25,487.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,223.82 / $15,910.21 / $23,295.05
| Facility | | $10,223.82 | $15,910.21 | $23,295.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,171.98 / $15,423.59 / $27,916.00
| Facility | | $11,171.98 | $15,423.59 | $27,916.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.75 / $163.57 / $260.69
| Facility | | $118.75 | $163.57 | $260.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,305.37 / $17,030.16 / $28,027.66
| Facility | | $12,305.37 | $17,030.16 | $28,027.66 |