- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,402.80 / $16,850.20 / $26,531.80
| Facility | | $12,402.80 | $16,850.20 | $26,531.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,096.73 / $15,408.74 / $22,560.82
| Facility | | $10,096.73 | $15,408.74 | $22,560.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,819.81 / $15,176.66 / $27,036.00
| Facility | | $10,819.81 | $15,176.66 | $27,036.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.01 / $158.41 / $252.48
| Facility | | $115.01 | $158.41 | $252.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,917.47 / $16,493.31 / $27,144.14
| Facility | | $11,917.47 | $16,493.31 | $27,144.14 |