- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,390.90 / $18,192.70 / $26,236.00
| Facility | | $13,390.90 | $18,192.70 | $26,236.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,781.88 / $16,611.88 / $24,206.80
| Facility | | $10,781.88 | $16,611.88 | $24,206.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,681.84 / $16,127.48 / $29,190.00
| Facility | | $11,681.84 | $16,127.48 | $29,190.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.29 / $171.04 / $272.58
| Facility | | $122.29 | $171.04 | $272.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,866.95 / $17,807.36 / $29,306.76
| Facility | | $12,866.95 | $17,807.36 | $29,306.76 |