- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,701.90 / $17,256.50 / $26,193.00
| Facility | | $12,701.90 | $17,256.50 | $26,193.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,335.70 / $15,773.44 / $23,094.80
| Facility | | $10,335.70 | $15,773.44 | $23,094.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,019.82 / $15,297.62 / $27,480.34
| Facility | | $11,019.82 | $15,297.62 | $27,480.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.78 / $162.24 / $258.56
| Facility | | $117.78 | $162.24 | $258.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,204.87 / $16,891.06 / $27,798.75
| Facility | | $12,204.87 | $16,891.06 | $27,798.75 |