- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,380.70 / $17,103.59 / $26,484.70
| Facility | | $12,380.70 | $17,103.59 | $26,484.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,074.33 / $15,374.55 / $22,510.76
| Facility | | $10,074.33 | $15,374.55 | $22,510.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,800.60 / $14,910.87 / $26,988.00
| Facility | | $10,800.60 | $14,910.87 | $26,988.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.80 / $158.13 / $252.03
| Facility | | $114.80 | $158.13 | $252.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,896.31 / $16,464.03 / $27,095.95
| Facility | | $11,896.31 | $16,464.03 | $27,095.95 |