- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,805.60 / $19,373.00 / $28,948.00
| Facility | | $13,805.60 | $19,373.00 | $28,948.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,239.34 / $17,123.89 / $25,020.62
| Facility | | $11,239.34 | $17,123.89 | $25,020.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,043.62 / $16,626.93 / $30,094.00
| Facility | | $12,043.62 | $16,626.93 | $30,094.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.00 / $176.34 / $281.02
| Facility | | $125.00 | $176.34 | $281.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,265.44 / $18,358.84 / $30,214.38
| Facility | | $13,265.44 | $18,358.84 | $30,214.38 |