- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,047.80 / $17,420.70 / $24,901.00
| Facility | | $13,047.80 | $17,420.70 | $24,901.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,324.74 / $16,179.51 / $23,634.00
| Facility | | $10,324.74 | $16,179.51 | $23,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,382.49 / $15,714.21 / $28,442.00
| Facility | | $11,382.49 | $15,714.21 | $28,442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $166.66 / $265.61
| Facility | | $120.00 | $166.66 | $265.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,537.23 / $17,351.04 / $28,555.77
| Facility | | $12,537.23 | $17,351.04 | $28,555.77 |