- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,475.30 / $18,307.30 / $26,624.00
| Facility | | $13,475.30 | $18,307.30 | $26,624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,970.49 / $16,714.28 / $24,422.12
| Facility | | $10,970.49 | $16,714.28 | $24,422.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,755.47 / $16,308.00 / $29,374.00
| Facility | | $11,755.47 | $16,308.00 | $29,374.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.06 / $172.12 / $274.31
| Facility | | $123.06 | $172.12 | $274.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,948.06 / $17,919.61 / $29,491.50
| Facility | | $12,948.06 | $17,919.61 | $29,491.50 |