- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,840.40 / $17,444.80 / $26,513.00
| Facility | | $12,840.40 | $17,444.80 | $26,513.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,245.79 / $15,944.40 / $23,345.11
| Facility | | $10,245.79 | $15,944.40 | $23,345.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,201.60 / $15,464.48 / $27,990.00
| Facility | | $11,201.60 | $15,464.48 | $27,990.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.07 / $164.01 / $261.38
| Facility | | $119.07 | $164.01 | $261.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,065.85 / $17,036.11 / $27,069.13
| Facility | | $12,065.85 | $17,036.11 | $27,069.13 |