- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,496.40 / $18,336.00 / $26,723.00
| Facility | | $13,496.40 | $18,336.00 | $26,723.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,680.51 / $16,720.21 / $24,389.18
| Facility | | $10,680.51 | $16,720.21 | $24,389.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,773.88 / $16,254.55 / $29,420.00
| Facility | | $11,773.88 | $16,254.55 | $29,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.26 / $172.39 / $274.74
| Facility | | $123.26 | $172.39 | $274.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,304.92 / $17,924.14 / $28,452.08
| Facility | | $12,304.92 | $17,924.14 | $28,452.08 |