- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,012.90 / $17,679.09 / $23,823.20
| Facility | | $13,012.90 | $17,679.09 | $23,823.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.70 / $16,160.94 / $23,574.25
| Facility | | $10,471.70 | $16,160.94 | $23,574.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,289.67 / $15,601.30 / $28,153.26
| Facility | | $11,289.67 | $15,601.30 | $28,153.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $166.21 / $264.89
| Facility | | $120.00 | $166.21 | $264.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,503.73 / $17,304.68 / $28,479.46
| Facility | | $12,503.73 | $17,304.68 | $28,479.46 |