- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,485.80 / $24,782.00 / $33,842.60
| Facility | | $18,485.80 | $24,782.00 | $33,842.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,472.46 / $22,302.02 / $33,408.69
| Facility | | $14,472.46 | $22,302.02 | $33,408.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,238.59 / $21,477.77 / $39,993.78
| Facility | | $14,238.59 | $21,477.77 | $39,993.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $229.83 / $376.30
| Facility | | $150.00 | $229.83 | $376.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,762.48 / $24,582.57 / $40,457.18
| Facility | | $17,762.48 | $24,582.57 | $40,457.18 |