- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,838.60 / $17,442.30 / $27,464.10
| Facility | | $12,838.60 | $17,442.30 | $27,464.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,447.73 / $15,944.40 / $23,345.11
| Facility | | $10,447.73 | $15,944.40 | $23,345.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,200.00 / $15,462.27 / $27,986.00
| Facility | | $11,200.00 | $15,462.27 | $27,986.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.05 / $163.98 / $261.35
| Facility | | $119.05 | $163.98 | $261.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,336.23 / $17,072.86 / $28,097.94
| Facility | | $12,336.23 | $17,072.86 | $28,097.94 |