- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,413.80 / $16,865.09 / $23,691.00
| Facility | | $12,413.80 | $16,865.09 | $23,691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.75 / $15,394.43 / $22,493.62
| Facility | | $9,823.75 | $15,394.43 | $22,493.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,829.41 / $15,190.13 / $27,060.00
| Facility | | $10,829.41 | $15,190.13 | $27,060.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.11 / $158.56 / $252.70
| Facility | | $115.11 | $158.56 | $252.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,928.05 / $16,507.95 / $27,168.24
| Facility | | $11,928.05 | $16,507.95 | $27,168.24 |