- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,240.40 / $17,988.20 / $25,304.00
| Facility | | $13,240.40 | $17,988.20 | $25,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,477.20 / $16,418.45 / $23,924.94
| Facility | | $10,477.20 | $16,418.45 | $23,924.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,550.57 / $15,946.26 / $28,862.00
| Facility | | $11,550.57 | $15,946.26 | $28,862.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.92 / $169.12 / $269.52
| Facility | | $120.92 | $169.12 | $269.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,722.37 / $17,607.25 / $28,977.45
| Facility | | $12,722.37 | $17,607.25 | $28,977.45 |