- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,299.20 / $19,426.70 / $29,164.00
| Facility | | $14,299.20 | $19,426.70 | $29,164.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,635.14 / $17,658.37 / $25,901.75
| Facility | | $11,635.14 | $17,658.37 | $25,901.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,474.23 / $17,221.43 / $31,170.00
| Facility | | $12,474.23 | $17,221.43 | $31,170.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.00 / $182.64 / $291.08
| Facility | | $125.00 | $182.64 | $291.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,739.74 / $19,015.25 / $31,294.68
| Facility | | $13,739.74 | $19,015.25 | $31,294.68 |