- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,441.30 / $16,902.50 / $23,743.60
| Facility | | $12,441.30 | $16,902.50 | $23,743.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,013.85 / $15,454.33 / $22,543.50
| Facility | | $10,013.85 | $15,454.33 | $22,543.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,853.42 / $14,983.80 / $27,120.00
| Facility | | $10,853.42 | $14,983.80 | $27,120.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.37 / $158.91 / $253.26
| Facility | | $115.37 | $158.91 | $253.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,954.50 / $16,544.56 / $27,228.48
| Facility | | $11,954.50 | $16,544.56 | $27,228.48 |