- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,751.60 / $21,399.90 / $32,075.00
| Facility | | $15,751.60 | $21,399.90 | $32,075.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,679.78 / $19,422.00 / $28,545.12
| Facility | | $12,679.78 | $19,422.00 | $28,545.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,741.27 / $18,970.64 / $34,336.00
| Facility | | $13,741.27 | $18,970.64 | $34,336.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.16 / $195.84 / $320.64
| Facility | | $137.16 | $195.84 | $320.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.31 / $20,946.68 / $34,473.33
| Facility | | $15,135.31 | $20,946.68 | $34,473.33 |