- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,610.20 / $18,490.59 / $29,114.70
| Facility | | $13,610.20 | $18,490.59 | $29,114.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,868.83 / $16,873.57 / $24,654.87
| Facility | | $10,868.83 | $16,873.57 | $24,654.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,873.13 / $16,654.13 / $29,668.00
| Facility | | $11,873.13 | $16,654.13 | $29,668.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $167.79 / $267.42
| Facility | | $120.00 | $167.79 | $267.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,077.65 / $18,098.96 / $29,786.67
| Facility | | $13,077.65 | $18,098.96 | $29,786.67 |